The Health Care Views and Experiences of Rural Americans: Findings from the Kaiser Family Foundation/Washington Post Survey of Rural America

Survey Methodology

The Washington Post/Kaiser Family Foundation Survey Project is a partnership combining survey research and reporting to better inform the public. The Post-Kaiser Survey of Rural America, the 31st in this series, was conducted by telephone April 13 – May 1, 2017, among a random representative sample of 1,070 adults age 18 and older living in rural counties, 303 adults in urban counties, and 307 in other counties that were considered suburban. Interviews were administered in English and Spanish, combining random samples of both landline and cellular telephones. Sampling, data collection, weighting and tabulation were managed by SSRS in close collaboration with The Washington Post and Kaiser Family Foundation researchers.

Respondents’ metropolitan status was operationalized using the CDC’s 2013 NCHS Urban-Rural Classification Scheme for Counties. Respondents were asked for their county of residence (or zip code if they were unsure) and classified into one of 6 codes in the classification scheme. Those in groups 4-6 (Small Metropolitan, Micropolitan, and Noncore) were considered Rural, those in group 1 (Large Central Metropolitan) were considered Urban, and the rest (Large Fringe Metropolitan, Medium Metropolitan) were considered Suburban.

The sampling procedures were designed to oversample those living in rural areas, with minimum goals for reaching rural residents who were between the ages of 18-34; Hispanic; black residents of Southern states; and residents of the rust belt states of Iowa, Michigan, Minnesota, Ohio, Pennsylvania, and Wisconsin. Some respondents were reached by calling back those living in rural areas who had previously completed an interview on the SSRS Omnibus poll and indicated they fit one of these oversample criteria. The dual frame landline and cellular phone sample was generated by Marketing Systems Group (MSG) using random digit dial (RDD) procedures.

All respondents were screened to verify that they belonged to the correct metropolitan classification. For the landline sample, respondents were selected by asking for the youngest adult male or female currently at home based on a random rotation. If no one of that gender was available, interviewers asked to speak with the youngest adult of the opposite gender. For the cell phone sample, interviews were conducted with the adult who answered the phone.

A multi-stage weighting design was applied to ensure an accurate representation of the population of each race group, within each of the three metropolitan areas and for both the cell phone and landline frames. The first stage of weighting involved corrections for sample design, including accounting for non-response for the re-contact sample. In the second weighting stage, demographic adjustments were applied to account for systematic non-response along known population parameters. Population parameters included gender, age, race, Hispanicity, education, region, and phone status (cell phone only or reachable by landline). The rural sample was also weighting based on metropolitan subgroup (category NCHS code 4, 5, or 6). Population parameters were derived using Census-based estimates provided by Nielsen Pop-Facts through Marketing Systems Group. Estimates of phone status were derived from the SSRS Omnibus 2016-2017 data.

All sampling error margins and tests of statistical significance have been adjusted to account for the survey’s design effect, which is 2.5 for results based on the full sample. The design effect is a factor representing the survey’s deviation from a simple random sample, and takes into account decreases in precision due to sample design and weighting procedures. Sample sizes and margin of sampling errors for key groups are shown below; other subgroups are available by request. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll.

This questionnaire was administered with the exact questions in the exact order as appears in the survey topline document. If a question was asked of a reduced base of the sample, a parenthetical preceding the question identifies the group asked. Some questions were only asked of those in rural areas.

Since some of the demographic questions could be sensitive and due to the nature of the survey content, interviewers were given specific instructions on how to cope with respondents who refused questions, including a statement reaffirming that answers were recorded confidentially for the sole purpose of research.

The Washington Post and the Kaiser Family Foundation each contributed financing for the survey, and representatives of each organization worked together to develop the survey questionnaire and analyze the results. Each organization bears the sole responsibility for the work that appears under its name. The project team from the Kaiser Family Foundation included: Mollyann Brodie, Ph.D., Liz Hamel, and Bryan Wu. The project team from The Washington Post included: Scott Clement and Emily Guskin. Both The Washington Post and the Kaiser Family Foundation public opinion and survey research are charter members of the Transparency Initiative of the American Association for Public Opinion Research.

Focus Group Methodology

As part of this project, the Kaiser Family Foundation and The Washington Post conducted two focus groups in Ashtabula County, Ohio. Participants were residents of Ashtabula County who reported voting in the 2016 presidential election. One group of 8 participants reported voting for Donald Trump and the second group of 8 participants reported voting for Hillary Clinton or another candidate (in the final group selected, 7 participants reported voting for Mrs. Clinton and one reported voting for Gary Johnson). Respondents were recruited by telephone, and screening criteria were used to exclude those who:

• had lived in the county for less than one year;
• themselves or a family member were employed by an elected official, political campaign, market research company, or media organization;
• had participated in a focus group in the previous three months;
• had an annual household income of $100,000 or more;
• reported a race other than white if they were a Trump voter; or
• reported a score lower than 7 when asked how comfortable they were voicing their opinions in a group setting on a scale from 1 to 10.

Each session was held at a restaurant in Jefferson, Ohio on May 4, 2017, and each lasted approximately one hour and 40 minutes. Each respondent received $100 for their participation. Both sessions were audio and video recorded for reporting purposes. The groups were moderated by Kaiser Family Foundation staff, and both Kaiser and The Post contributed financing for the recruiting and recording. The group discussion guide is available upon request.