As you know, one commonly used tool for collecting data for a research study is an interview. Interviews are often structured through the use of a standard problemnaire.

Dr. Iwant T. Know has identified a problem in his clinic. Many pediatric patients continue to have respiratory infections despite the use of several types of antibiotics. He recently read an article (Urganci, et. al, 2003) that found that acute lower respiratory tract infection was a symptom in severely malnourished children. Several nurses had noted that many children were underweight. The clinic serves many immigrants from various countries and the nurses have noted that parents do not seem to understand basic nutrition. Dr. Know would like to plan a qualitative study to research the problem and identify some solutions. 

As you prepare your problemnaire, keep in mind the following:

The focus of the problemnaire will be to identify factors that might contribute to malnourishment
The underweight children are likely to be immigrants from various countries 
Parents of the children may have no knowledge of basic nutrition
Some of the native foods might not be available in the local community
Parents might not be aware of how they might use available foods for preparing their native dishes
The information gathered from the problemnaire will contribute to a study using an ethnography design
Your paper will include two parts. 

Part 1: Survey Document 

Your survey document should include the following: 

A cover letter to the potential participants. describe the purpose of the problemnaire in the form of a cover letter to potential participants. Be sure to include why it is important for them to participate and encouragement to do so. 
Create an appropriate problemnaire for a study using ethnology research for Dr. Know's patients. You must include 10-15 problems of varying types, including at a minimum: 
Two fixed alternative problems that have only two choices for the answer, 
Five fixed alternative problems with 4-5 potential answers, 
One open-ended problem, and 
Any other combination of problems to make a minimum of 10 problems 


Part 2: Data collection method 

In approximately one page discuss the format you will use to collect the information (mail, internet, phone, group, or face to face interview). Justify your choice in terms of a qualitative design using ethnography. 

Your paper should comply with Standard English and use APA references and citations in Part 2 of your paper. 

The score sheet is included below with several hints.