Bhatta, Prakash

Simkhada, Padam

van Teijlingen, Edwin

English

Bournemouth University Research Online

Wilderness and Environmental Medicine, 17, 295 296 (2006)Letter to the EditorImportance of Piloting a Questionnaire on SexualHealth ResearchTo the Editor:Over the past few years there has been a growing interestin the importance of pilot studies in health science re-search.1 Pilot studies should provide insight into the re-search issues being studied and/or provide informationabout relevant field questions and about the logistics ofthe field inquiry. These 2 functions of the pilot study arenot the same because the term pilot study has 2 distinctmeanings: first, feasibility studies, that is, ‘‘small-scaleversion[s], or trial run[s], done in preparation for themajor study’’2; and second, pretesting one’s research in-strument.3We conducted a pilot study among 10 trekker guidesin Nepal prior to attempting a larger study of the sexualbehavior among such guides. The main aims of this pilotstudy were to test and refine the research question, themethods, and the tools for data collection with respectto both the contents (quality) of the data and the pro-cedures to be followed.Because little research exists on sexual health issuesin Nepal, particularly related to trekking guides, therewere no existing questionnaires or interview schedulesthat could be used in a public health study of the sexualhealth and behavior of this population. A questionnairewas, therefore, drafted on the basis of a previous projectconducted by one of the authors,4 our review of the lit-erature on sexual health, and previous sexual healthquestionnaires used in other countries. The questionnaireconsisted of 10 parts, starting with demographic detailsof the respondents, and continuing with sections on, forexample, attitudes towards sexual health, sexual rela-tionships with foreign women, and smoking and drink-ing habits.Based on this descriptive analysis and feedback fromthe research participants, we highlight here some of theissues and lessons learned from the pilot study.● The pilot study suggested that the guides (9 of 10participants) liked having the questionnaire written inCorresponding author: Padam Simkhada, Department of PublicHealth, University of Aberdeen, Foresterhill, Aberdeen, Scotland,United Kingdom (e-mail: p.p.simkhada@abdn.ac.uk).Note: A copy of the questionnaire is available from the correspond-ing author.2 languages (English and Nepali); they felt that com-pleting the questionnaire allowed them to practice ortest their English. Using 2 languages meant that thequestionnaire was nearly double the word length,which resulted in methodological problems.● In lifestyle or health promotion studies in industrial-ized countries, it is common practice to ask about thenumber of units of alcohol consumed in a certain pe-riod. However, in Nepal, where people use a lot ofhome-made alcohol with varying alcohol levels, a unitof alcohol is impossible to establish.● As in all studies involving more than 1 language,there are issues of translation.5 For example, ‘‘drunk-enness’’ has 2 distinct translations in Nepali, 1 mean-ing mildly drunk and 1 meaning very drunk or ‘‘leg-less.’’● Some of the sexual behaviors, although easily trans-latable in Nepali, do not make sense to all. Thus,‘‘oral sex’’ needs to be described rather than justtranslated. Sometimes the terminology in Nepali isobscure/odd, and in everyday language it is easier tosimply use the English term. In our questionnaire, theterm ‘‘anal sex’’ was substituted for the Nepali trans-lation.● The question on drug misuse was not effective be-cause no one admitted to drug use in the question-naire. Informal discussions with respondents and oth-er guides, however, suggested that smoking marijuanais a fairly widespread practice among these individ-uals. We conclude that this question was too sensitive.It is common practice in Nepal to smoke hashish(marijuana), but people are reluctant to admit it dueto fear of legal reprisal.● Feedback during the pilot study (from all participants)suggested that the original title, ‘‘Sexual BehaviorAmong Young Nepalese Trekking Guides,’’ was toosensitive. The title was therefore changed to the moregeneral ‘‘Reproductive Health and Personal BehaviorSurvey Among Trekking Guides in Nepal 2005.’’● We asked in the pilot if people had used a condomduring their last intercourse. When they replied‘‘yes,’’ we intended for the participants to next answera question about why they had done so. If they hadnot used a condom during their last intercourse, wemeant for them to answer the question ‘‘Why not?’’However, what happened was that nearly all respon-dents answered both questions. We suspect this was296 Letter to the Editorbecause the instructions were unclear, and after a longdiscussion we decided to change the question to ‘‘Onoccasions you used condoms, why did you do so, andon occasions you didn’t, why didn’t you?’’ This meantthat all respondents were expected to answer both,because the first question included the multiple choiceanswer ‘‘I never use condoms,’’ and the latter one hadas possible answers ‘‘I always use condoms.’’● In Nepali the symbols ‘‘’’ (a cross) and ‘‘’’ (a tick)have different connotations. A cross is associated witha negative answer and a tick with a positive one.Common questionnaire instructions in English are‘‘Please tick one of the boxes’’ or ‘‘Please put a crossin the box.’’ We had to change the instructions tomake it clearer to the respondents what we wished forthem to do.Translation issues are to be expected when workingwith 2 languages and cultures.5 However, some of theissues that occurred in our pilot study were unexpected,even though the first 2 authors are both Nepalese. Forexample, the notion of ticks and crosses is culturallyspecific.Conducting a pilot study is a crucial element of a goodstudy design, and it is very helpful to pilot a newly de-signed questionnaire. Questions need to be culturally ap-propriate to be of use in public health research.Acknowledgment. We would like to thank all partic-ipants. We acknowledge Dr. Roger Ingham and NicoleStone at Southampton University and trekking compa-nies at Nepal for their support. The fieldwork of thisstudy was enabled through small grants from the UKDepartment for International Development, Safe Passag-es to Adulthood Programme, coordinated by the Uni-versity of Southampton.Padam SimkhadaDepartment of Public HealthUniversity of Aberdeen, ScotlandPrakash BhattaResearch and Action Nepal (RAAN)Nayabazar Kathmandu, NepalEdwin R. van TeijlingenPublic Health & Dugald Baird CentreUniversity of Aberdeen Medical SchoolScotlandReferences1. Van Teijlingen ER, Hundley V. The importance of pilotstudies. Soc Res Update. 2001;35. Available at: http://www.soc.surrey.ac.uk/sru/SRU35.html. Accessed January11, 2006.2. Hundley V, van Teijlingen E. The role of pilot studies inmidwifery research. RCM Midwives J. 2002;5:372–374.3. Cohen L, Manion L. Research Method in Education. Lon-don: Rutledge; 1989.4. Bhatta P. Sexual Behaviour of Trekking Guides: An Analysisof Knowledge of Condom Use and STDs and HIV/AIDS inNepal [unpublished Master’s thesis]. Kathmandu, Nepal:Tribhuvan University; 2003.5. Birbili M. Translating from one language to another. SocRes Update. 2000;31. Available at: http://www.soc.surrey.ac.uk/sru/SRU31.html. Accessed April 12, 2006.

Sexual Behaviour of Trekking Guides: An Analysis of Knowledge

The importance of pilot studies. Soc Res Update.

The role of pilot studies in midwifery research.

Translating from one language to another. Soc Res Update.

Importance of Piloting a Questionnaire on Sexual Health Research: Letter to the editor

Importance of Piloting a Questionnaire on Sexual Health Research: Letter to the editor

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