Data collection is no simple task – it requires thoughtfulness and consideration to prevent bias that skews results. When collecting equity data, it is important to be aware of the different factors that could skew results. Among other factors, studies show that question order can lead to response bias, or a form of bias that results from how a survey is constructed. As healthcare professionals, we must be intentional about the ordering of questions when creating health equity surveys in order to reduce response bias and collect better data. 

Question order can lead to response bias through anchoring or priming. Anchoring is when the wording of a question sets a tone that influences how that question and/or subsequent questions are answered. Very similarly, priming is when questions or data introduced earlier in a survey affects a respondents answer to questions later on.

If you are creating an employee engagement survey to determine how comprehensive employees’ equity training has been, and you ask respondents to fill in an hour-value for their training, you may anchor respondents to equate the value of their training with how long their training was, rather than the quality and depth of that training. Likewise, if you ask respondents to list how their equity training was helpful to them early in the survey, then ask them to rate how helpful their training was later on in the survey, they may be primed to rate their training higher since they listed out ways that their training was helpful to them beforehand.

Question order also matters because of primacy and recency bias. Primacy and recency bias is the idea that what we see first and last in a survey sticks with us the most. Considering this, it is important to be thoughtful about your first and last survey questions.

Finally, we must consider respondent drop-off/fatigue. Surveys, especially long ones, can be draining and tedious. This can affect how respondents approach later survey questions. 

Some of the steps we can take while creating surveys in order to reduce response bias and collect better equity data include starting off with straightforward questions and leaving sensitive questions until the end, randomizing question order in the middle, keeping the survey short and succinct, and using plain language. More on this advice, along with a more in-depth explanation of the biases mentioned, can be found in this Qualitics article.