Hint: ask a few questions daily, and let your client respond electronically.

Finding the right way to ask questions and get the information you want may seem like an inscrutable art. Much research in psychology and related disciplines aims to understand what particular features of questionnaires and surveys entice the highest response rates and yield the most precise information from respondents. The findings suggest the following three aspects make great questionnaires:

1. Keep it short

Surveys that take more than five minutes to answer often go unanswered. Respondents begin to answer longer surveys, but do not finish (they drop-out). To increase the chances that your client will answer questions completely, and finish the survey daily, surveys should be kept as short as possible. The figure below shows just how quickly response rates declined with survey time in a paper-based questionnaire (1)

Response rates decline rapidly as surveys get longer.

Response rates decline rapidly as surveys get longer.

2. Ask questions daily

Accurately recalling emotions, behaviors, and symptoms over long periods of time is notoriously difficult for most people. Few people have trouble describing how they are presently feeling, but recalling the ups and downs of the last week can be challenging. Research has shown that questions about health and well-being become unreliable if the respondent needs to recall a period longer than a day or two (2). Therefore, it is no wonder that many approaches to psychotherapy choose daily tracking as the preferred method of data collection. In fact, the more frequently you survey, the better able you are to detect changes in your clients as they progress through their therapeutic program. Daily assessment for as few as 36 days allow you enough statistical power to analyze your data and detect improvements in your client’s symptoms.

Filippo Aschieri and Justin Smith (3) report on a case study of a female therapy client named Claire (a pseudonym). Claire, tracked a short 6-item survey of her symptoms for 5 weeks; the first week of this data collection was before Claire and her therapist began working on her symptoms — this period was used as the baseline for her symptoms. After the first week, Claire and her therapist began intensive work, all the while she continued to track her symptoms. The figure below, taken from the paper, clearly shows how Claire’s daily symptoms changed following her first therapeutic session. This change in Claire’s daily symptoms over the period of 28 days, can be detected using standard statistical methods.

The change in Claire’s daily symptoms over the period of 28 days.

3. Collect data electronically

The impetus for creating Mentegram (Youcognize) came when I realized that many clinicians were asking their clients to track their daily moods and behaviors on paper-based mood charts. I personally cannot imagine carrying around a piece of paper and remembering to respond to it. Research supports my aversion to analog tracking; only 11% of clients whose counselors asked them to fill out daily assessments on paper did so diligently (4). Paper has become an inconvenience to most adults.

In the last few years, researchers have looked into tracking clients through text messages and smartphone apps, and found that data collected via phones is not only more complete, but also more reliable. A number of studies found phone-based response rates between 88% and 93%, in such diverse settings as adults in psychotherapy tracking daily moods (4), adolescents with cancer (5) or sickle cell disease (6) tracking their daily symptoms, and middle aged women tracking their daily activity level (7).

More importantly, when researchers compared client’s responses with their clinical professional’s evaluation, electronic responses were correlated with the clinician’s assessment, but paper responses were not (8).

Tracking daily moods and behavior over smartphones lead to remarkably improved data completeness.

The take-away

Data can be invaluable in therapy, but only when the data is of great quality. The best approach to data collection involves frequent, short questionnaires, administered electronically. That is the foundation upon which we have built Mentegram (mentegram.com) — delivering the power of great information to your fingertips, so that you can transform it into wisdom, and fantastically effective therapy.

References

  1. Cape (2010). Questionnaire Length, Fatigue Effects and Response Quality Revisited. (LINK)
  2. Kitching, Moren & Valenciano (2013). Preventing Bias. (LINK)
  3. Aschieri & Smith (2012).The effectiveness of therapeutic assessment with an adult client: a single-case study using a time-series design. (LINK)
  4. Foreman, Bone, Hall & Kaplin (2011) Just Text Me: Using SMS Technology for Collaborative Patient Mood Charting (LINK)
  5. Baggott, Gibson, Coll, Kletter, Zeltzer & Miaskowski (2012). Initial Evaluation of an Electronic Symptom Diary for Adolescents with Cancer. (LINK)
  6. Jacob, Stinson, Duran, Gupta, Gerla, Lewis & Zeltzer (2o12). Usability Testing of a Smartphone for Accessing a Web-based e-Diary for Self-monitoring of Pain and Symptoms in Sickle Cell Disease. (LINK)
  7. Fukuoka, Kamitami, Dracup, & Jong (2011). New Insights Into Compliance With a Mobile Phone Diary and Pedometer Use in Sedentary Women. (LINK)
  8. Depp, Kim, de Dios, Wang, Ceglowski (2012). A Pilot Study of Mood Ratings Captured by Mobile Phone Versus Paper-and-Pencil Mood Charts in Bipolar Disorder. (LINK)
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