The Delaware Division of Public Health (DPH) receives funds from a cooperative agreement with the Centers for Disease Control and Prevention (CDC) to operate a state-based Behavioral Risk Factor Survey (BRFS) as part of the national Behavioral Risk Factor Surveillance System (BRFSS) which includes all 50 states, the District of Columbia, and three U.S. territories. Survey interviewing is conducted by Abt Associates, under contract with DPH.

CDC requires that a specified core questionnaire be used each year. However, the system provides some flexibility to meet state needs. States may select from a group of CDC-approved modules in addition to the core questionnaire. CDC's Division of Behavioral Surveillance provides basic analysis and tabulations of the core and module questions.

If space is available, states also have the ability to add local questions which can provide data to meet state-specific needs. Locally added questions are not analyzed by CDC, so the requesting DPH program must provide resources for field testing and data analysis.

This document defines the procedures and criteria to be used in determining which questions and/or modules will be added to the Delaware BRFS in a given year. To facilitate the process, the BRFS program has established an advisory committee which may review requests.

Limitations on Added Questions:

Time – Research about telephone interview surveys indicates that there is a time limit after which refusal rates increase and survey quality decreases. Therefore, the Delaware BRFS restricts the length of the average interview to 20 minutes. To accomplish this, we strive for an average questionnaire length of about 90-100 questions, with a 120-question maximum.

Cost – The DPH agreement with its contractor covers the cost of administering the core questionnaire and four to six modules per year (depending on length of the modules and skip patterns). Each additional question will result in additional cost, and DPH programs requesting additional questions must identify available funding to cover the added costs.

Procedures for Requesting Addition
of Data Items (Questions or Modules):

Requests for inclusion of additional data items, whether local questions or CDC-supported modules, will be reviewed and acted on by the BRFS coordinator, in consultation with the BRFS Users Group, the contractor, and the Division of Population Health at CDC.  If necessary to determine priorities, the advice of the committee and the coordinator may be referred to the Division Director for final recommendation.

Decisions regarding which questions or modules will be included in the survey will be made by October 1 of the year preceding the survey. The survey is conducted on a calendar-year basis.

Requests for additional data items should be made to the BRFS coordinator during the spring and summer of the year preceding the survey. All requests must be received by August 1 to be considered for the coming year. Late requests will be considered only for the Division's high-priority issues or for questions relating to timely or emergency issues, and must have the approval of the Division Director.

Emergency or Critical Health Issues:

The flexibility of the BRFS allows questions to be added for a portion of a year under certain circumstances. If a critical health issue or a statewide emergency develops about which the Division needs behavioral or attitudinal data, questions can be added to the BRFS at any time during the year. Requests for emergency or critical health issue questions must be reviewed and approved by the director of the Division of Public Health as “critical” or “emergency” questions.

Requests for added data items must contain the following information for review:

1. Reason for the request, with a statement of its relationship to objectives in appropriate DPH or statewide health plans.
2. How the data will be used by the program or agency, and who will benefit.
3. What other sources have been considered for obtaining the data, and reasons for choosing BRFS.
4. Estimated prevalence of the behavior or risk factor to be measured, based on other national or state surveys, or best available evidence. [Note:  Due to sample size issues, we do not recommend BRFS as a method for gathering data about behaviors with less than a 5% prevalence in the general adult population.]
5. If the request is not for a CDC-approved module, the number of questions to be asked and a draft of the proposed questions.
6. Amount and source of available funds to cover the request.
7. How frequently would the questions need to be asked (once only, annually, in alternate years, every five years, etc.) and justification. This should be based primarily on expectations for change in the prevalence.
8. Type of additional analysis the requesting program will conduct, and data needed for that analysis.
9. Prior use of the questions (have they been used in other states or other surveys; have they been cognitively tested and field tested?).

For locally developed questions, once accepted, the BRFS coordinator will work with the requester and the contractor on question wording, question placement and order, and cognitive and field testing. Final cost of locally added questions may need to be determined in negotiations with the contractor. The estimated cost is currently $4,000 per question.

Criteria for selecting modules:

• Are the questions needed to provide baseline data or track progress for objectives of an established public health program or statewide health plan?
• Is the module necessary for collecting baseline data for development of a new program?
• How much length (in terms of number of questions and time required to ask them) will the questions add to the survey?
• Is funding available to support the addition?
• Are other sources available for the data, or is there a more appropriate tool for collecting it?
• What is the feasibility of collecting an adequate sample size for the desired use?
• How will the data be used?
• Does the request originate within the Department of Health and Social Services, Division of Public Health; and will the data benefit the Division's programs?

Return to the main Delaware BRFSS page.