In survey-based health research, one of the earliest and most consequential methodological decisions is whether to develop a survey de novo or adapt an existing instrument. This choice affects not only study feasibility and comparability, but also validity, ethics, and respect for intellectual property.
Importantly, neither de novo nor adapted surveys are inherently superior. Both approaches are legitimate when used appropriately. What matters is that researchers conduct proper due diligence and make a transparent, well-justified decision suited to their research question, population, and context.
What Do We Mean by De Novo and Adapted Surveys?
A de novo survey is a measurement instrument developed from scratch. Items are generated specifically for a particular construct, population, or setting, often informed by literature reviews, focus group discussions, and key informant interviews.
An adapted survey is based on a previously developed instrument and modified for use in a new context. Adaptation may involve translation into another language, cultural modification, or contextual refinement to ensure relevance and comprehensibility for a different population.
Both approaches require careful planning and methodological rigor. Adaptation is not a shortcut, and de novo development is not automatically more innovative or precise.
When Is a De Novo Survey Appropriate?
Developing a survey de novo may be appropriate when:
The construct of interest is new or emerging
Existing instruments do not adequately capture the local context or population
The research question is highly context-specific, such as local health system practices or culturally bound behaviors
For example, a locally designed survey may be needed to assess knowledge and practices related to a newly implemented diabetes care pathway or a context-specific renal health education program.
However, de novo development requires substantial effort. Researchers must ensure content relevance, clarity, and coherence, and must plan for appropriate validation activities. Additionally, findings from de novo tools may be less directly comparable to existing studies.
When Is Survey Adaptation More Appropriate?
Adapting an existing instrument is often preferable when:
A well-developed tool already measures the construct of interest
Comparability with prior studies or international data is important
The construct is well-established, but the population or language differs
Examples include adapting validated quality-of-life instruments for patients with chronic kidney disease or translating and culturally adapting antenatal knowledge surveys for use in a different country or region.
Adaptation still requires rigor. Items must be evaluated for conceptual and contextual relevance, and modifications must preserve the underlying construct. Importantly, adaptation must follow ethical and legal standards regarding intellectual property.
The Importance of Due Diligence
The decision between de novo and adapted surveys should always begin with a thorough literature search. Researchers should determine:
Whether an existing instrument already measures the construct
How widely the instrument has been used
Whether it has been applied to similar populations or settings
Skipping this step risks unnecessary duplication of effort and weakens the study’s methodological foundation.
Respecting Intellectual Property and Licensing
When using or adapting an existing survey, researchers have an obligation to respect intellectual property rights. This includes:
Identifying the original developer or copyright holder
Determining whether permission or licensing is required for use, modification, or translation
Complying with stated terms and conditions
Properly acknowledging the original instrument in publications
Failure to address intellectual property concerns can lead to ethical issues, manuscript rejection, or restrictions on dissemination.
How to Decide: A Practical Framework
A structured approach can help guide decision-making:
- Clearly define the construct to be measured
- Conduct a comprehensive search for existing instruments
- Assess conceptual and contextual fit for the target population
- Evaluate feasibility, comparability, and ethical considerations
- Decide whether adaptation is sufficient or de novo development is necessary
These steps are intended as guides, not rigid rules.
The Role of Team and Adviser Consultation
Survey decisions should not be made in isolation. Input from:
- Co-investigators
- Methodologists
- Subject matter experts
- Mentors or advisers
is essential to ensure that choices are methodologically sound, ethically defensible, and aligned with study objectives.
Key Takeaway
Choosing between a de novo and an adapted survey is a methodological decision, not a value judgment. Both approaches are valid when used appropriately. What distinguishes high-quality survey research is not the choice itself, but the rigor, transparency, and ethical care with which that choice is made.
References
- Polit DF, Yang FM. Measurement and the Measurement of Change: A Primer for the Health Professions. Wolters Kluwer; 2016.
- De Vet HCW, Terwee CB, Mokkink LB, Knol DL. Measurement in Medicine. Cambridge University Press; 2011.
