Sample Questionnaire

Sample Questionnaire
Student’s Name:
Institutional Affiliation:
Abstract
Chronic illnesses are the major concern in the healthcare sector. These illnesses refer to conditions that have long-lasting impacts and which leave devastating effects on individuals, families and communities. This research paper identifies the main question as; ‘’the major causative factors of chronic illnesses’’ and proceeds to design a questionnaire that answers this question. This questionnaire divides questions into four major segments. The first is open-ended questions, followed by the close-ended and questions rated based on a Likert scale. The questions asked relate to the research questions and seek to fulfill the varied objectives of this research. This study selects the simple sampling technique as it is effective, time-saving, and flexible in the determination of the various causes of chronic illnesses. The simple sampling technique will involve a random selection of patients most affected by chronic illnesses. As the researcher, I will make hospital visits and establish patients with two or more chronic illnesses, establish causes, determine the diagnosis and medication are prescribed.
Keywords: sampling techniques, chronic illnesses, management of chronic conditions, diagnosis, clinical interventions, and healthcare sector.
Introduction
The purpose of this paper is to design a questionnaire that addresses a selected research question. The research question relates to the major causative factors of chronic illnesses.

This questionnaire divides questions into four major segments. The first is open-ended questions, followed by the close-ended and questions rated based a Likert scale. The questions asked relate to the research questions and seek to fulfill the varied objectives of this research. I confirm that this is my original work and any information derived from outside sources is cited accordingly based on standard formatting and citation.
Research Question
What are the major factors leading to chronic conditions and what are the major pointers or indicators for chronic diseases?
Sample Population
The sample population for this study is persons suffering from chronic diseases such as cancer, cardiopulmonary conditions, arthritis, and diabetes. The sample population will include older persons who are affected by the immediate effects of these conditions.
Sampling Methods
Sample methods reflect the approaches and strategies that can be utilized in the determination of samples. The most popular sampling techniques include; cluster sampling, simple sampling, stratified, random, and strategic sampling methods. This study selects the simple sampling technique as it is effective, time-saving, and flexible in the determination of the various causes of chronic illnesses (Jacobsen, 2016).
The simple sampling technique will involve a random selection of patients most affected by chronic illnesses. As the researcher, I will make hospital visits and establish patients with two or more chronic illnesses, establish causes, determine the diagnosis and medication are prescribed. The hospital surveys will also include discussions with health care providers and practitioners to establish the underlying causes of chronic conditions.
The sampling method will also take into consideration institutions and organizations that are keen to diagnose and consequently management chronic illnesses. Proper measures and interventions will be considered in the identification of the relevant samples. Measures like propensity of illnesses, severity, and target groups are critically underpinning.
Questionnaire
Open-ended Questions
How long have you suffered from this particular chronic condition?
When did the symptoms and signs first manifest?
How can you describe this condition in terms of manifestation, duration, and effects of the symptoms?
What do you think were the most causative factors?
Kindly describe a combination of causes for your chronic illness.
Close-ended Questions
What do you think are the main causes of chronic conditions?
[a] Poor lifestyle
[b] Poor feeding habits
[c] Lack of exercises
How can you classify the intensity of this condition?
Not so intense
Slightly intense
Very intense
What do you think should be done to avoid the causes of chronic illnesses?
Community awareness
Clinical evaluation and implementation of clinical approaches
Provision of education and training to practitioners and communities at large
Rating Scale Questions
Kindly rate the severity of chronic illnesses on a scale of 1 – 10. 10 being the worst and 1 being the least severe…………………………………………………
Kindly rate the manner in which hospitals and healthcare providers are concerned about chronic illnesses on a scale of 1 – 5…………………………………………
Please rate the societal intervention and awareness about the degree of chronic illnesses on a scale of 1 – 5………………………………………………………..
Likert Scale Questions
Were you aware of the causes of chronic conditions before?
Very much aware
Slightly aware
Not aware
Are the people close to you aware of the impacts and management practices?
Very much
Not really
Not all
How would you classify the intensity of chronic illnesses?
Very severe
Moderate
Low
Do you think hospitals and healthcare centers leverage the relevant practices in the diagnosis and management of chronic illnesses?
Not really
A lot
Moderately
Poorly
References
Jacobsen, K. H. (2016). Introduction to Health Research Methods. Burlington: Jones & Bartlett Learning