Proceedings: Indoor Air 2002

A SOCIOLOGICAL APPROACH TO VALIDATE A QUESTIONNAIRE

FOR THE ASSESSMENT OF SYMPTOMS AND PERCEPTION OF
INDOOR ENVIRONMENT IN DWELLINGS

K Engvall1,2*, C Norrby1 and E Sandstedt3,4

1
Stockholm Office of Research and Statistics, Stockholm, Sweden
2
Department of Medical Science/ Occupational and Environmental Medicine, Uppsala
University, Sweden
3
Institute of Housing and Urban Research, Uppsala University, Sweden
4
Department of Sociology, Uppsala University, Sweden

ABSTRACT
A standardised questionnaire for dwellings the Stockholm Indoor Environment
Questionnaire (SIEQ) was developed, based on sociological principles and test procedures for
validation. The every day language describing the building and its function was first obtained
by qualitative personal interviews, then by standardised questions. The interview
questionnaire was transformed into a postal self- administered questionnaire. The
questionnaire was reduced by correlation analysis. It was found that to obtain a good validity,
general questions are not sufficient, but also questions on perception and observations are
needed. Good test- retest agreement was found for a random sample when investigating the
same area, and the same buildings.

INDEX TERMS
Questionnaire, Validation, Indoor environment, Sick building syndrome (SBS), residential

INTRODUCTION
There has been increasing concern about the indoor environment, during the latest decades.
Demands for energy saving and introduction of new building materials and building
technology, can be difficult to combine with demands for a better indoor environment
(Thorton, 1994). During the same period, there were reports on building related symptoms in
modern office buildings (Kreiss, 1989), and possible health risks with emissions from
building materials (Wieslander et al., 1997). The phenomena was called the sick building
syndrome (SBS) (Kreiss, 1989). Moreover, respiratory health problems related to growth of
moulds and bacteria in damp buildings have been recognised as a major problem in many
countries (Bornehag et al., 2001). The issue of the indoor environment was initially
approached from either a technical or a medical point of view. Technical investigations or
exposure measurements in the indoor environment have been performed without taking the
response of the inhabitant into account. Traditionally, technical data from buildings have been
compared with technical standards, e.g. for ventilation (ASHRAE, 1999) and thermal comfort
(Fanger, 1988). Medically orientated investigations have mostly been based on self-
administered questionnaires, even though there are few studies on medical symptoms among
adults in relation to domestic exposures (Norlen and Andersson, 1993). Symptoms in relation
to the indoor environment include ocular, nasal, throat and facial dermal but also headache,
tiredness and difficulties concentrating. These symptoms often called the sick building
syndrome (SBS), but the symptoms are non-specific and can occur for many reasons.

*
Contact author email:karin.engvall@beteendeperspektiv.se

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There are many reasons to apply a sociological perspective on the indoor environment. The
interaction between the building and the inhabitant is of great importance, particularly in
technically advanced modern buildings. Life-style and handling of technical installations may
influence the function of building installations as well as the indoor air quality. The
perception of different aspects of the indoor environment is a key issue, since it influences
both the behaviour and the comfort of the inhabitant. Moreover, perceptions and medical
symptoms are not only related to the physical indoor environment, but also influenced by
social and cultural impacts, organisational aspects, life-style as well as personality aspects and
other individual factors (Stenberg and Wall, 1995; Sandstedt and Thielman, 1999).

The main aim was develop a standardised questionnaire for dwellings the Stockholm Indoor
Environment Questionnaire (SIEQ), based on sociological principles and test procedures for
validation.

METHODS
The development of the structured validated self-administered postal questionnaire with
standardised layout, was done in four steps:

(1) Identify expressions in the every day language describing characteristics of the building
and its function, from the occupants perspective. This was done in order to achieve a good
content validity. A pilot study was performed with qualitative interviews during 1-2 hours,
with open questions and open-ended answers.
(2) Select significant aspects of the indoor environment in dwellings, based on information
obtained from the qualitative interviews in order to achieve both a good content and internal
validity. A standardised interview questionnaire with both open-ended answers, and closed
questions was constructed.
(3) Transform the standardised interview questionnaire into a reduced postal questionnaire.
Questions were reduced and specified, and open answers were transformed into fixed
alternatives. The selection procedure was based on correlation analyses.
(4) Test the standardised self-administered questionnaire and the number of questions was
further reduced, by selecting specific questions with the highest correlation with the general
question on the indoor environment, and by omitting questions that did not add significant
information.

The order, in which questions are presented, may influence the answers (Sudman and
Bradburn, 1982; Karlton G and Schuman H. 1982). Initial questions in SIEQ deals with
general attitude to the apartment to minimise spill over effects" of emotional feelings on the
reporting of environmental factors. The environmental questions in the questionnaire starts
with the perception of thermal climate, ventilation, and different aspects of air quality. The
respondent is asked to notice specific aspects and perceptions in different rooms, before they
make the general judgement of the variables. Asking about health can be a delicate issue in
ordinary residential building, that is why these questions are surrounded by more neutral
environmental questions concerning acoustic perceptions and illumination. Finally, there are
background questions about the apartment, as well as personal and household factors.

Reliability was investigated on area level, and building level, by comparing prevalence of
symptoms and complaints when applying the questionnaire twice. Statistical testing was made
by chi-square analysis for four-fold contingency tables. Test-retest on the individual level was
investigated by comparing individual answers when applying the questionnaire twice, with

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two years time difference. Proportion of subjects with full agreement was calculated, defined
as proportion of subjects giving the same answers twice. In addition, Cohens kappa value
was calculated.

RESULTS
An overview of variables used in the Stockholm Indoor Environment Questionnaire is given
in Figure 1. Building information was collected from the central building register or the
building owners. Information on the dwelling was collected in the questionnaire. The dwelling
variables were selected in co-operation with technical staff at Environment and Public Health
Administration in Stockholm. Population characteristics as personal factors, household
factors, behavioural aspects, and attitudes were collected from the questionnaire. The
questionnaire contained a few questions on medical conditions, such as asthma, hay fever, and
eczema. The health variables totally included seven symptoms and were adopted from the
Swedish MM questionnaire (Andersson and Stridh, 1992).

Building Population Indoor environment Health

-ventilation personal factors: air quality: SBS-

-heating -age -air, symptoms:
-building age -gender -diffuse odour, -ocular
-building size -atopy -specific odour -nasal
-ownership -current smoking -moisture, -throat
-rebuilding household : thermal comfort: -cough
-size -air temperature, -facial dermal
Dwelling -marital status -warmth/cold surface, -headache
-sum of children -drought, -fatigue
-size behaviour: -humidity
-floor -airing habits sound quality:
-population -cleaning habits -diffuse noise
density -residency time -specific noise
-water leakage attitudes: illumination:
-condense -dwelling -daylight
-redecoration satisfaction -sunlight

Figure 1 Variables studied in the Stockholm Indoor Environment Questionnaire (SIEQ)

The interview questionnaire obtained in step two contained totally 250 questions. Initially,
seven multifamily houses with totally 350 apartments were included, and one adult was
randomly selected from each apartment. Totally 41 were excluded, either because they did not
live in the dwelling (migration), or because they had lived in the apartment less than one year.
The target population was 309 subject, 287 participated (93%). In the reduction process 205
questions were excluded, leaving 45 questions to be included in the self-administered
questionnaire. Questions dealing with general judgements of the indoor environment (content)
were correlated with different every day language expressions on specific aspects of the
indoor environment variables (internal), and the internal variables with the lowest correlation
values were excluded. Some specified questions that did not correlate but obvious was related
to technical functions were kept in the questionnaire. In step three, the self-administered
questionnaire was distributed among 82 subjects in three multi-family buildings, 75

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participated (91%). A further reduction from 45 to 33 questions was made, based on

correlation values, applying the same principle for exclusion of internal variables (Table 1).
Table 1. Correlation matrix for indicator air quality to catch the conclusive question
"What is your opinion of the air quality in general in the living-room, bedroom, apartment
as a whole?"
Summary Air Ventilation in general in Ventilation in general in the
judgement of the air quality different part of the apartment different periods of
quality dwelling the year
kitchen LR bathr bedr spring summer autumn winter
air quality 1.00 0.48 0.60 0.27 0.74 0.60 0.60 0.68 0.70
dry/ humid -0.56 -0.33 -0.32 -0.18 -0.43 -0.43 -0.18 -0.45 -0.49
clean / dusty 0.66 0.29 0.31 0.09 0.31 0.41 0.40 0.42 0.45
fresh/ stale 0.71 0.40 0.40 0.08 0.56 0.37 0.37 0.38 0.44
own cooking smell -0.34 -0.51 -0.22 -0.19 -0.38 -0.46 -0.25 -0.30 -0.45
neighbours cooking -0.12 -0.40 0.03 -0.18 0.08 -0.29 -0.20 -0.24 -0.31
smell
other smell from -0.24 -0.29 -0.01 -0.14 -0.17 -0.21 -0.30 -0.30 -0.25
neighbours
smells from outside -0.19 -0.17 -0.24 -0.14 -0.22 -0.30 -0.20 -0.20 -0.33
difficulties drying
damp towels in the -0.02 0.19 -0.09 -0.22 -0.12 -0.20 -0.20 -0.20 -0.19
bathroom
condensation bet- 0.04 0.16 0.07 -0.26 0.12 -0.14 -0.18 -0.20 -0.22
ween windowpanes
condensation -0.11 0.17 -0.04 -0.37 -0.07 -0.17 -0.18 -0.22 -0.22
inside the window
pungent odour 0.20 -0.07 -0.04 -0.05 0.23 -0.05 -0.05 -0.06 -0.07
mouldy odour 0.06 0.28 0.10 0.33 0.23 0.35 0.36 0.37 0.35
musty odour 0.55 0.39 0.41 0.08 0.57 0.31 0.35 0.47 0.52
stuffy odour 0.27 -0.14 0.06 0.02 0.14 0.17 0.00 0.18 0.21
LR = living room

A high response rate and little loss of information are of great importance for the internal
validity. The SIEQ has been used in more than 900 multifamily buildings with answers from
about 20 000 dwellings. The response rate has mostly been over 75% often 85-90%, and
partial loss of data due to lack of answers from specific questions is low. In a stratified
random sample of 9 808 responders, 71% of the questions had a drop out of less then 6%.
The only exception was the question asking if the symptoms were related to the home
environment. This question was not answered by 13%-22% of the respondents. The highest
drop out was on home-related facial dermal symptoms.

The reliability of a questionnaire refers to what extent the respondent's gives the same
information when the questionnaire is applied repeated times. Since seasonal variations can be
of importance, reliability was tested at the same winter period (December-February). The
reliability of SIEQ was tested on three different levels: area level, building level, and
individual level. Two repeated random surveys were performed in the same local area within
one year, with similar prevalence of complaints and symptoms. Reliability on the building
level was studied by two repeated surveys in one new multifamily building, with two years
difference. No changes in the technical systems or management of the buildings occurred

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during the follow-up period. A similar prevalence of complaints and symptoms was obtained
(Table 2). Reliability on the individual level was investigated by comparing individual
answers in the building survey in the new building mentioned above. Data will be presented
Table 2. Reliability study of SIEQ on tree different levels; random survey in the same area,
repeated survey in the same building and repeated survey comparing individual answers.
Population Same local area Same building
Questions about: 1991 1993 1998 2000
1 (N=935) (N=3241) (N=36) (N=37)
Environment
(%) (%) (%) (%)
Dissatisfaction with the apartment 4 4 6 0
Dissatisfaction with indoor air 9 10 6 5
quality
- musty odour 21 17 3 6
- dry air 37 38 13 15
- dusty air 23 27 40 43
Dissatisfaction with thermal comfort 18 19 9 11
- draught living-room 37 37 28 35
- cold floors 38 34 18 24
2
Symptoms
Ocular 6 7 10 21
Nasal 8 12 26 22
Throat 5 7 31 20
Cough 6 6 10 11
Facial dermal 6 7 7 9
Headache 8 7 13 9
Fatigue 23 21 28 26
None of the differences were statistically significant (p>0.05).
1
General dissatisfaction and environmental complaints dichotomised 2Symptoms "yes,
often/every week". 3Complaints "very bad/fairly bad"

DISCUSSION
Questionnaire studies on sick building syndrome (SBS) have mainly been dealing with work-
environments (e.g. offices, schools and hospitals) and there is a lack of studies in dwellings.
In the beginning this meant that questionnaires used for homes were the same as for other
buildings. Therefore SIEQ was developed, as the homes are such different environments
compared to the public and private milieus of productivity, work relationships and personal
density. This means that the questions are different and more oriented to how the dwelling is
disposed, used and controlled in different rooms, activities and situations.

Validations of SBS symptom questionnaires have been published (Raw et al., 1994; Raw et
al., 1996). Other indoor questionnaires at this time were developed and tested in the
laboratory (Fanger, 1988) or in workplaces (Andersson and Stridh; 1992). To our knowledge,
SIEQ is the first validated questionnaire particularly developed to deal with a broad aspect on
the indoor environment in multi-family houses, not only SBS-symptoms. The validation of the
questionnaire was performed in three steps, following common principles used in sociology
(Sudman and Bradurn, 1982; Karlton G and Schuman H. 1982). By selection specific
questions with the highest correlation with general judgements on the indoor environment, a
content validity and internal validity was achieved. To our knowledge, a similar validation
procedure has not been previously described for currently used indoor questionnaires. No

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systematic differences in the answer were observed, either on an area level or building level,
when applying the questionnaire after one or two year, during the same season (winter).

ACKNOWLEDGEMENT
This study was supported by grants from the Building Research Foundation (BFR), the City
of Stockholm, The Gothenburg Energy Foundation, and The Stockholm Building Society.

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