2019 Questionnaire Redesign

Overview

The content and structure of the NHIS will be updated in the redesign to better meet the needs of data users. Aims of the redesign are to improve the measurement of covered health topics, reduce respondent burden by shortening the length of the questionnaire, harmonize overlapping content with other federal health surveys, establish a long-term structure of ongoing and periodic topics, and incorporate advances in survey methodology and measurement.

Timeline

To ensure that the NHIS continues to collect data of the highest quality, and to allow more time for field and process testing, the redesigned instrument will be introduced later than originally planned.

In January 2018, the National Center for Health Statistics (NCHS) will field a survey instrument with the same structure as the current NHIS, consisting of a household interview, family interview, sample adult interview, and sample child interview.

NCHS intends to conduct two tests. The first is a small test of survey procedures to be done in mid-2018. The second test will be a field test during which the redesigned questionnaire will be administered to half of households in the sample. This test will run from October through December of 2018. The redesigned instrument will be fully launched in January 2019.

Proposed Redesign

The comments received throughout 2015, 2016, and 2017 have been instrumental in determining the survey content for the redesigned NHIS. Below are detailed outlines of core topics in the sample adult and sample child questionnaires.

Detailed outline of core topics in the sample adult questionnaire [PDF – 235 KB]

Detailed outline of core topics in the sample child questionnaire [PDF – 239 KB]

Complete sample adult and sample child questionnaires will be released later in 2017.

Redesigned Questionnaire Structure

One “sample adult” aged 18 years or older and one “sample child” aged 17 years or younger (if any children live in the household) will be randomly selected from each household following a brief screener that identifies the age, sex, race, and ethnicity of everyone who usually lives or stays in the household. Information about the sample adult will be collected from the sample adult him/herself unless s/he is physically or mentally unable to do so, in which case a knowledgeable proxy can answer for the sample adult. Information about the sample child will be collected from a parent or adult who is knowledgeable about and responsible for the health care of the sample child. This respondent may or may not also be the sample adult.

In the current NHIS, questions from the family questionnaire are asked about the family as a whole and about each member of the family. The NHIS has consistently defined a family as an individual or a group of two or more people residing together who are related by birth, marriage, or adoption. A family additionally includes any unrelated children who are cared for by the family (such as foster children) and any unmarried cohabiting partners and their children. In the redesigned NHIS, the definition of family will remain the same.

In the redesigned survey, family-level content will be collected in the sample adult and/or sample child questionnaire. Much of the content that is now collected in the family section will be collected within the sample adult and sample child questionnaires. There is some loss of the content that has previously been collected in the family questionnaire, including: detailed relationships of all family members to household and family respondent, country of birth (if not US), some employment and earnings information, active duty military time periods, instrumental activities of daily living (IADLs), disability-associated conditions, receipt of medical advice by phone, and amount of money that the family spent out of pocket for medical care.

An estimated 35,000 interviews are expected to be available annually for analysis in the redesigned NHIS. The redesign allows for data users to pool two or more years of sample if needed to produce reliable estimates for population subgroups.

The redesigned sample adult and sample child questionnaire structures will consist of four components: the annual core, rotating core, sustaining supplements, and periodic supplements.

Annual Core

The annual core questionnaire will contain the same questions from year to year. These questions focus on demographic characteristics, health insurance, health conditions, and disability.

Rotating Core

The rotating core questionnaire consists of questions that will be included in the interview on some years with fixed periodicity. The core questions (both the annual and rotating) are sponsored by NCHS and reflect the prioritized content areas. Efforts have been made to ensure that rotating content on the sample adult and sample child interviews is consistent, so that similar topics are addressed in both the sample adult and sample child interviews in a given year.

Sustaining and Periodic Supplements

Supplements are questions funded by other federal agencies. In the past, supplements have included content on food security, cancer screening, complementary and alternative medicine, and heart disease, among others. A list of NHIS supplements and co-sponsors is available for download. Sustaining sponsors are agencies that will sponsor content every year over multiple years; these supplements do not need to contain the same questions from year to year. Periodic supplements will consist of sponsored content that will be included in the interview in one or more years, but not every year.

Content Order

The proposed periodicity of each rotating core topic and years in which rotating core sections will first appear is available in the content draft documents above.

In households with children, the order of the sample adult and sample child interviews will vary by household. The relationship between the sample adult and sample child will be obtained. When the sample adult and sample child are in the same family, content areas that refer to the family will be captured only once, in whichever interview comes first. When they are not, questions about the family will be asked in both the sample adult and the sample child interviews.

Rationale for Redesign and Criteria for Prioritizing Content

In general, the following criteria have been used for prioritizing content to be included in the redesigned questionnaire:

• Strong link to public health
• Relevant to HHS agency goals, strategic plans, or initiatives
• Long-term monitoring of the topic area is needed
• Topic area can be measured well in household interviews
• Measure is used by other federal surveys for calibration
• Measure does not duplicate the detail collected by federal surveys with more targeted purposes
• Topic area can be estimated reliably with only one or two years of data

Content areas with a strong link to public health include:

• Leading causes of morbidity/mortality
• Intermediate health outcomes for leading causes of morbidity/mortality
• Targets of major federal health promotion initiatives
• Health insurance coverage
• Health care access and utilization
• Individual behavioral risk or protective factors for the content areas listed above
• Other factors that identify priority populations at elevated risk of poorer health or receiving poorer health care

Public Redesign Outreach Activities to Date

In October 2015, February 2016, and June 2016, NCHS requested input on the proposed NHIS questionnaire redesign. Many suggestions were received; the most frequent areas of input were requests to retain detailed questions about disability, health behaviors, health care access and utilization, mental health, specific chronic conditions, health insurance, and the health of other family members. In October 2016, NCHS requested public comments through the Federal Register. The most frequent requests were for additional questions on dental and oral health, behavior of children aged 0-1 years, adult disability, and allergies.

Some comments were incorporated into the redesigned core questionnaire. The redesigned NHIS will continue to identify people with functional limitations and difficulties. A battery of mental health questions to assess depression and anxiety will be added to the new rotating core. Chronic conditions with sufficient prevalence were considered for inclusion. Some data on family relationships will be collected, including marital status of sample adults and parents of sample children. Several family context variables will be retained, including race/ethnicity, education, and employment status of all adults in the family.

Comments were also received that have not been incorporated into the current questionnaire. Topics such as caregiving burden, social isolation, or food insecurity may be incorporated occasionally (i.e., without a set periodicity) or as supplemental content sponsored by another federal agency rather than added to the NHIS core. Other topics may be more appropriate for other federal surveys. For example, nutritional inventories (including details on common allergens) and health expenditure amounts are collected in detail in other surveys.

The next public comment period will be through the Federal Register later in 2017. Until then, comments may be directed via email.