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          For example, a survey question that asks graduates   5.   Leggett TD, Eatmon S. Data analysis: closing the loop in assess-
          whether they are prepared to take the American         ment. Radiol Technol. 2017;88(5):545-547.
          Registry of Radiologic Technologists exam might ben-  6.   Newcomer KE, Hatry HP, Wholey JS. Handbook of Practical
          efit from a neutral answer option because making such   7.   Program Evaluation. 4th ed. Wiley; 2015.
                                                                 Loftus EF. Planting misinformation in the human mind: a
          a selection is easier than admitting they are unprepared.   30-year investigation of the malleability of memory. Learn Mem.
          In the absence of a neutral response, graduates who do   2005;12(4):361-366.  doi:10.1101/lm.94705
          not feel prepared might choose a positive response to   8.   Schwarz N, Strack F, Mai H. Assimilation and contrast effects in
          avoid admitting their concerns.                        part-whole question sequences: a conversational logic analysis.
            One also should consider that providing options      Public Opin Q. 1991;55(1):3-23. doi:10.1086/269239
          such as “Do Not Know” or “No Opinion” discourages   9.   Thau M, Mikkelsen MF, Hjortskov M, Pedersen MJ. Question
                                                                 order bias revisited: a split‐ballot experiment on satisfaction with
          thought about the topic and increases the likelihood of   public services among experienced and professional users. Public
          a nonresponse.  In addition, program surveys soliciting   Adm. June 22, 2020;1-16.
                      6
          feedback from communities of interest should ask ques-  10.  Questionnaire Design. Pew Research Center. Published 2017.
          tions targeted to the respondent, thereby eliminating   Accessed September 9, 2020. https://www.pewresearch.org
                                                                 /methods/u-s-survey-research/questionnaire-design/
          the need for a “Not Applicable” option.            11.  Chyung SY, Roberts K, Swanson I, Hankinson A. Evidence‐
                                                                 based survey design: the use of a midpoint on the Likert scale.
          Conclusion                                             Perform Improv. 2017;56(10):15-23. doi:10.1002/pfi.21727
            Developing a survey to solicit responses from a   12.  Johns R. One size doesn’t fit all: selecting response scales for atti-
          program’s communities of interest to identify areas for   tude items. J Elections Public Opin Parties. 2005;15(2):237-264.
                                                                 doi:10.1080/13689880500178849
          improvement can be beneficial and provide reliable   13.  Edwards ML, Smith BC. The effects of the neutral response
          information if developed properly. Understanding the   option on the extremeness of participant responses. J Undergrad
          thought process regarding how respondents answer sur-  Scholarsh. 2014;6.
          vey questions can provide unique insight and capture   14.  Krosnick JA. Survey research. Annu Rev Psychol. 1999;50(1):537-
          the intended data.                                     567. doi:10.1146/annurev.psych.50.1.537



            Chad Hensley, PhD, R.T.(R)(MR), serves as secretary-
          treasurer on the Joint Review Committee on Education in
          Radiologic Technology board of directors. He also is the
          radiography program director for the University of Nevada,
          Las Vegas.

          References
          1.   Joint Review Committee on Education in Radiologic
              Technology. Standards for an accredited educational program
              in radiography. Published April 2020. Accessed September 9,
              2020. https://www.jrcert.org/sites/jrcert2/uploads/documents
              /2021_Standards/2021_Standards_Radiography.pdf
          2.   Jabine TB, Straf ML, Tanur JM, Tourangeau R, eds. Cognitive
              Aspects of Survey Methodology: Building a Bridge Between
              Disciplines. National Academy Press; 1984:73-100.
          3.   Tourangeau R. The survey response process from a cognitive
              viewpoint. Qual Assur Educ. 2018;26(2). doi:10.1108/QAE-06
              -2017-0034
          4.   Krosnick JA. Response strategies for coping with the cognitive
              demands of attitude measures in surveys. Appl Cogn Psychol.
              1991;5(3):213-236. doi:10.1002/acp.2350050305


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