a questionnaire design and one page illustration of the questionnaire

· Is the purpose of the instrument clear?

· Are the directions clear?

· Is the format inviting?

· Are items clear (e.g., unambiguous, language appropriate, etc.)?

· Are questions numbered?

· Does it allow for ease of response?

· Is the length respectful of respondents’ time?

· Is the information organized to ease data collection and summary?

· Are limited response items used when appropriate?

· Are open-ended response item used when appropriate?

· Is there enough space/time for responses?

Written Surveys, Focus Group & Interview Protocols:

· Have you asked, “Is there anything else I need to know or that you would like to share with me?”

· Have you thanked participants for responding to the questionnaire?

Focus Groups & Interviews

· Do participants have a copy of the questions?

C. Pilot Testing Steps:

· Did you use your crosswalk or logic model to develop the questions?

· Has someone else reviewed the questionnaire or protocol to make sure you’ve asked the questions that need asking?

· Have questions with multiple meanings been removed?

· Is the language appropriate to the audience?

· Has a group, similar to your selected group, tried to complete it?

· Will the pilot test data answer the questions of interest?