The effect of question order on reporting physical activity and walking behavior

Area of Science:

• Public Health
• Epidemiology
• Survey Methodology

Background:

• Self-reported physical activity (PA) is crucial for public health surveillance.
• The order of questions in surveys, such as the Behavioral Risk Factor Surveillance System (BRFSS), may influence reported PA levels.

Purpose of the Study:

• To investigate the impact of question order on self-reported regular PA using BRFSS PA module items.
• To determine if placing walking questions before moderate and vigorous PA questions biases results.

Main Methods:

• A telephone survey was administered using two forms with different PA question orders: standard (moderate-PA, vigorous-PA, walking) and alternate (walking, moderate-PA, vigorous-PA).
• Weighted and adjusted rates of vigorous PA, walking, meeting PA recommendations, and moderate PA were compared between the two forms.
• Sample sizes were N = 1004 for the standard form and N = 212 for the alternate form.

Main Results:

• Vigorous PA and walking reports were similar across both question orders.
• Meeting Centers for Disease Control and Prevention (CDC) PA recommendations was reported less frequently with the alternate form in 18- to 34-year-olds.
• Moderate PA was underreported with the alternate form overall, and specifically among 18- to 34-year-olds, women, whites, and individuals with a high school education or less.

Conclusions:

• To accurately estimate PA and walking across diverse sociodemographic groups, moderate-PA and vigorous-PA questions should precede walking questions.
• Initiating a survey with walking questions may introduce bias, particularly affecting moderate PA estimates.
• The placement of walking questions after moderate and vigorous PA items in BRFSS surveys is recommended to mitigate potential bias.