特殊人群信访应答率的logistic分析

为了解信访调查法实际应用的应答率及有关影响因素，探讨适合应用的靶人群特点，选择曾入院手术的女性乳腺癌病人，进行信访调查。单因素分析，居住地、年龄和职业对应答率产生影响。Ｌｏｇｉｓｔｉｃ回归分析表明，３０－６０岁各年龄别、从事专业技术工作的人员对应答率产生正面的影响，而农民这个变量对应变量则产生负向影响。研究结果提示，对同质性高、人口学特点单一的靶人群信访，应答率可能较高     

Participation in a mail survey: role of repeated mailings and characteristics of nonrespondents among recent mothers

This study analysed the characteristics of respondent and nonrespondent mothers at each stage of a survey procedure, from a initial questionnaire to a reminder letter and two repeated mailings. Of 938 mothers of liveborn children who, while maternity inpatients, received a questionnaire and information about a mail survey to follow 2 months later, 828 completed and returned the initial questionnaire, 708 agreed to participate in the mail survey and were sent the mail questionnaire, and 612 finally completed and returned the questionnaire at 2 months. There were differences between respondents and non-respondents for socio-demographic factors at each stage of the process. The final response rate to the mail questionnaire was higher among mothers who were younger, were breast feeding, and had more education, an occupation and fewer children. The characteristics of late respondents were intermediate between those of early to middle respondents and nonrespondents for age, educational level, breast feeding and occupation. Maternal and infant health varied only slightly according to response status. Repeated mailings increased response and diminished selection. A mail questionnaire after contact in a maternity ward is a cost-effective means of gathering data about a large sample of recent mothers and their children.     

A comparison of cigarette smokers recruited through the Internet or by mail.

OBJECTIVES: To compare smokers recruited by mail or through the Internet. METHODS: A questionnaire was mailed to 19,352 inhabitants of Switzerland in 1998, in an effort to enroll them in a smoking cessation trial. The same questionnaire was also available on the Internet. Furthermore, we mailed a survey to a representative sample (n = 1000) of the population of Geneva, Switzerland, in 1996. In this study, we compare three groups: 1027 smokers recruited through the Internet, 2961 volunteer trial participants recruited by mail (response rate 16%), and 211 smokers in the representative sample also recruited by mail (response rate 75%). RESULTS: Smokers self-recruited through the Internet were younger, more educated, more motivated to quit smoking and smoked more cigarettes per day than smokers in the other samples. Compared to trial participants, Internet participants had more negative attitudes towards smoking, higher self-efficacy scores, and were more addicted to tobacco. The strength of associations between smoking-related variables was similar in Internet and trial participants. CONCLUSION: As expected, the three groups of smokers differed on several characteristics. However, bias in distributions of variables did not imply bias in associations between variables. Thus, Internet recruitment is a potentially useful method for analytical studies that focus on associations between variables.     

Women in an infertility survey responded more by mail but preferred a choice: randomized controlled trial

ObjectivesTo evaluate three modes of questionnaire completion (online, mail, and telephone) and a choice group for a questionnaire survey with a sensitive topic.Study Design and SettingA randomized trial of alternative completion methods (online, paper [mail], telephonic interview, and a choice of the three modes) for a survey about fertility problems embedded within a population-based cross-sectional survey of reproduction among women living in England and Wales.ResultsFrom an initial cohort of 21,036 women who were sent a screening questionnaire, 4,559 responded. A total of 699 women reported fertility problems, of whom 593 (85%) agreed to participate. A total of 521 (75%) of the 699 women then completed the survey. Compared with the “mail” arm, those allocated to telephonic interview were less likely to agree to participate initially (odds ratio [OR], 0.41; 95% confidence interval [CI]: 0.22, 0.74) but were ultimately more likely to complete the questionnaire (OR, 2.20; 95% CI: 1.01, 4.80). Overall, those allocated to the choice arm were most likely to go through to completion (80% vs. 77% mail, 72% telephone, and 68% online groups). In the choice arm, women showed a clear preference for mail (59% vs. 37% choosing online and 3% telephonic response).ConclusionsOnline surveys are a viable alternative to mailed questionnaires but were not as popular as mail in this study population. Response can possibly be increased by offering women a choice of response modes.     

Registered post achieved a higher response rate than normal mail--a randomized controlled trial

OBJECTIVE: The aim was to study the most effective method for increasing response rates to postal questionnaires by comparing normal post with registered mail and to assess the cost implications of the two mailing methods. STUDY DESIGN AND SETTING: General Practitioners in Victoria (n=1,550) were randomized to receive a research questionnaire via either normal post or registered mail. RESULTS: The overall response rate for the study after two reminders was 76.1% (1,179/1,550). After the initial mail out the response rate for the registered mail arm was 55.9% (n=433) compared to the normal post arm, 40.1% (n=311, P-value <0.001). After the first and second reminders the response rates dropped, registered mail obtained a response rate of 47.4% (n=162) and 37.8% (n=68), respectively, compared to a response rate of 28.0% (n=130) and 22.5% (n=75) for normal post. Overall, the cumulative response rate for the registered mail was greater, 85.6% (n=663) compared to 66.6% (n=516) for the normal post arm (P-value <0.001) There was a total cost difference between the registered and normal method of AUD $1,531.50. CONCLUSION: Registered post when used for mail out of the initial questionnaire and all subsequent reminders is a more effective yet more expensive method for achieving a high response rate.     

Reducing questionnaire length did not improve physician response rate: a randomized trial

ObjectivesTo examine the effect of reducing questionnaire length on the response rate in a physician survey.Study Design and SettingA postal four double-page questionnaire on end-of-life decision making was sent to a random sample of 1,100 general practitioners, 400 elderly care physicians, and 500 medical specialists. Another random sample of 500 medical specialists received a shorter questionnaire of two double pages. After 3 months and one reminder, all nonresponding physicians received an even shorter questionnaire of one double page.ResultsTotal response was 64% (1,456 of 2,269 eligible respondents). Response rate of medical specialists for the four double-page questionnaire was equal to that of the two double-page questionnaire (190 and 191 questionnaires were returned, respectively). The total response rate increased from 53% to 64% after sending a short one double-page questionnaire (1,203–1,456 respondents).ConclusionThe results of our study suggest that reducing the length of a long questionnaire in a physician survey does not necessarily improve response rate. To improve response rate and gather more information, researchers could decide to send a drastically shortened version of the questionnaire to nonresponders.     

Use of medications by elderly Brazilian retirees: 1--methodology and response rates of a multicenter survey

This paper reports methodological aspects and response rates of a survey with the main objective of describing the drug utilization profile of retirees of the Institute of National Social Security of Brazil, 60 years of age or older, in three simple random samples: Brazil (countrywide), Belo Horizonte municipality, and Rio de Janeiro municipality. This cross-sectional study employed two approaches: mail (self-report questionnaires) and home interviews (questionnaires completed by interviewers). This strategy allowed evaluation of response agreement between the mail and home interview approaches. In the national sample of 3,000 individuals, 1,025 only responded to the self-report questionnaire. Despite this the low response rate, there was reasonable resemblance between respondents and non-respondents, suggesting that this sample is representative of the target population. In Belo Horizonte and Rio de Janeiro the initial samples of 800 individuals were replicated for both approaches, mail and home interview. The response rates to the mail surveys were 46.8% and 34.4% in Belo Horizonte and Rio de Janeiro, respectively. The response rates to the home interviews were 80.3% and 70.7% in Belo Horizonte and Rio de Janeiro, respectively, after unavoidable attrition.     

Cost-effectiveness of a lottery for increasing physicians' responses to a mail survey

To evaluate the cost-effectiveness of a lottery on physicians' responses to a mail survey, a randomized controlled trial was conducted with a random sample of 1,000 members of the Quebec Federation of General Practitioners in 1997. For the first mailing of this survey, each respondent was randomly assigned to the control or experimental group, which was offered participation in a lottery upon return of the questionnaire. Response rate was 41.2% in the experimental group and 34.8% in the control group, a 6.4% difference (CI95%: 0.6%-12.6%). The additional cost of the lottery was about Can$500, giving an incremental cost of Can$16 per questionnaire returned. In conclusion, a lottery resulted in a small but statistically significant increase in the response rate of physicians to a mail survey. This method may be a cost-effective option when applied to large surveys.     

The effects of lottery incentive and length of questionnaire on health survey response rates: a randomized study.

Maximizing the response rate of self-administered questionnaires is key in survey research. We aimed to evaluate the effects of lottery incentive and length of questionnaire on health survey response rates when used in isolation or combined. A random sample of 440 residents in Western Sydney, Australia was randomly allocated to four equal groups to receive or not receive an instant lottery ticket and a long (seven page) or short (one page) questionnaire. The overall response rate was 71.8%. The final response rates were higher among those receiving the short, rather than the long, questionnaire (75.6% versus 68.2%) (P = 0.08); and among those receiving the lottery incentive compared with those not receiving the incentive (75% versus 68.2%) (P = 0.09). By logistic regression analysis, the success of obtaining a completed questionnaire without any follow-up reminders was significantly associated with the lottery incentive but not the questionnaire length (P = 0.03 and P = 0.54, respectively). The difference between lottery and no lottery groups decreased gradually during the follow-up. A lottery incentive is associated with an increased response after the first mailing. A small up-front cost for a lottery ticket may be worthwhile, since it can save further costs by obviating the need for repeated follow-ups.     

National health surveys by mail or home interview: effects on response

STUDY OBJECTIVE: To study the effect of using a mail questionnaire or home interviews on the size and the selectivity of response to national health surveys. DESIGN: The interview survey and the mail survey were both carried out in the same country (the Netherlands) using the same sample frame, the same study period (1998) and collected partly the same data on demographic, socioeconomic and health characteristics. SETTING: The Netherlands. PARTICIPANTS: Dutch non-institutionalised inhabitants aged 25 years and over. MAIN RESULTS: Response to the mail survey was lower (46.9%, n=3664) than to the interview survey (58.5%, n=6061). The mail survey gave higher response rates for women and lower response rates for persons with lower levels of education. Respondents to the mail survey reported lower rates of smoking but a slightly worse health status and higher figures on the use of health care services. No differences by method of data collection were found for age, marital status, region, household composition, work status and categories of body mass index. CONCLUSION: Although the response of the mail survey was lower than the home interview survey, respondents showed generally small differences, with exception of level of education.     

Impact of reminders and method of questionnaire distribution on patient response to mail-back satisfaction survey.

Nonresponse and methods of data collection could affect satisfaction measurement. The goal of this study was to estimate the impact of (1) nonresponse and (2) distribution method on evaluation of patient satisfaction in a mail-back study measuring patient opinion of medical and nursing care. The study was conducted in an adult hospital. Patients were pseudo-randomized according to the initial mode of questionnaire distribution (given at hospital or sent by mail). Three reminders were made at 1-week intervals to nonrespondents, regardless of the method of initial questionnaire distribution. Groups were distinguished according to the delay of response: initial (before any reminder), middle (after one or two mailed reminders), and late respondents (after mailed reminders plus telephone contact). The study included consecutively discharged patients to obtain 300 patients per arm. 482 patients returned the questionnaire (248 in the group receiving the questionnaire at the hospital and 234 in the other group). Groups were compared for satisfaction scores and delay of response. Early respondents were compared with middle and late respondents for patient characteristics, modality of hospital care, and satisfaction scores. Multivariate analyses were performed. Participation rate before any reminder was higher when the questionnaire was mailed than when it was given at the hospital (45% versus 39.7%, p = 0.03). The initial method of distribution did not influence patient satisfaction level. Satisfaction did not differ between respondents with or without reminders. Distributing questionnaires by mail may be preferred to distribution at discharge to optimize response rate. Reminders do not seem necessary to estimate satisfaction of overall potential respondents.     

Pre-notification did not increase response rate in addition to follow-up: a randomized trial

ObjectiveAlthough there is growing evidence on the effectiveness of pre-notification and follow-up on response rates in patient surveys, no studies report the effectiveness of pre-notification in addition to follow-up. The aim of this study was to determine the effect of a pre-notification by mail on the response rate in a patient survey with follow-up, compared with follow-up or pre-notification only.Study Design and SettingRandomized trial that compared (1) a combination of pre-notification and follow-up with (2) pre-notification only and (3) follow-up only. The trial was integrated in a survey study among patients, which measured their experiences with general practice cooperatives for out-of-hour care.ResultsOf the total number of 880 patients who received the questionnaire, 45% returned it. No significant effect was found of the combination of pre-notification and follow-up compared with the two other arms of the trial.ConclusionAdding pre-notification to follow-up in a patient survey had no additional effect on the response rate. This finding must be interpreted with respect to the questionnaire and the study population.     

Rural physicians' perspectives on cervical and breast cancer screening: a gender-based analysis

Several studies highlight the role of physicians in determining cervical and breast cancer screening rates, and some urban studies report higher screening rates by female physicians. Rural women in North America remain underscreened for breast and cervical cancers. This survey was conducted to determine if there were significant gender differences in practices and perceptions of barriers to breast and cervical cancer screening among rural family physicians in Ontario, Canada. One hundred ninety-one family physicians (response rate 53.1%) who practiced in rural areas, small towns, or small cities completed a mail questionnaire. The physicians' mean age was 44.4 years (SD 9.9), and mean number of years in practice was 16.6 years (SD 10.3). Over 90% of physicians reported that they were very likely to conduct a Pap test and clinical breast examination (CBE) during a periodic health examination, and they had high levels of confidence and comfort in performing these procedures. Male (68%) and female (32%) physicians were similar in their likelihood to conduct screening, levels of confidence and comfort, and knowledge of breast and cervical cancer screening guidelines. However, the self-reported screening rates for Pap tests and CBE performed during last year were higher for female than male physicians (p < 0.01). Male physicians reported they were asked more frequently by patients for a referral to another physician to perform Pap tests and CBE (p < 0.001). Also, male physicians perceived patients' embarrassment as a stronger barrier to performing Pap tests (p < 0.05) and CBE (p < 0.01) than female physicians. No gender differences were observed in screening rates or related barriers to mammography referrals. These findings suggest that physicians' gender plays a role in sex-sensitive examination, such as Pap tests and CBE. There is a need to facilitate physician-patient interactions for sex-sensitive cancer screening examinations by health education initiatives targeting male physicians and women themselves. The feasibility of providing sex-sensitive cancer screening examinations by a same-sex health provider should also be explored.     

Outpatient satisfaction: validation of a French-language questionnaire: data quality and identification of associated factors

OBJECTIVES: Following 1996 legislation requiring French hospitals to assess patient satisfaction, this study developed and validated a brief French-language multidimensional questionnaire designed to measure outpatient satisfaction with hospital visits and compared data quality for two patient-satisfaction survey methods. DESIGN: Authors developed a 19-item questionnaire following a strict procedure (identification of dimensions to explore, formulation, and selection of items). SETTING: Validation data were obtained from patients of six outpatient clinics in a teaching hospital. PARTICIPANTS: 586 consenting eligible patients were randomized to receive the questionnaire 2 weeks after their visit with one of two survey methods: a mailed self-administered questionnaire or a telephone interview. RESULTS: The response rate (79%) was not significantly different between the two survey methods. The risk of having one or more missing values was higher in the mail survey group (odds ratio, 1.65; 95% confidence interval, 1.03-2.63), but mail respondents were less likely to use the "extremely positive" response category. Principal component analysis identified four factors that accounted for 56% of the variance: interpersonal skills and information transfer, physical surroundings, convenience, and appointment delay. Patients' comments on open-ended questions validated the semantic content of the factorial construct. The internal consistency coefficient was greater than 0.70 for three of four subscales. Patient background characteristics accounted for less than 10% of the factorial score variance. Patient satisfaction was correlated with age, type of visit, and, to a lesser extent, gender and education level. CONCLUSION: This easily administered, multidimensional out-patient-satisfaction questionnaire provided encouraging preliminary psychometric characteristics.     

Enhancing response rates in physician surveys: the limited utility of electronic options

Objective. To evaluate the utility of offering physicians electronic options as alternatives to completing mail questionnaires. Data Source. A survey of colorectal cancer screening practices of Alabama primary care physicians, conducted May–June 2010. Study Design. In the follow‐up to a mail questionnaire, physicians were offered options of completing surveys by telephone, fax, email, or online. Data Collection Method. Detailed records were kept on the timing and mode of completion of surveys. Principal Findings. Eighty‐eight percent of surveys were returned by mail, 10 percent were returned by fax, and only 2 percent were completed online; none were completed by telephone or email. Conclusions. Offering fax options increases response rates, but providing other electronic options does not.     

Can incentives undermine intrinsic motivation to participate in epidemiologic surveys?

Response rates to surveys are decreasing. The purpose of this study was to evaluate the use of lottery tickets as incentives in an epidemiologic control group. A self-administered questionnaire was sent to parents in the municipality of Stockholm, Sweden, who were to be used as a control group in a study addressing stress in parents of children with cancer. A stratified random sample of 450 parents were randomized into three incentive groups: (a) no incentive; (b) a promised incentive of one lottery ticket to be received upon reply; (c) a promised incentive of one lottery ticket to be received upon reply and an additional lottery ticket upon reply within 1 week. The overall response rate across the three groups was 65.3%. The response rate was highest in the no incentive group (69.3%) and lowest in the one plus one lottery ticket group (62.0%). In a survival analysis, the difference between the two response curves was significant by the log-rank test (P = 0.04), with the no incentive group having a shorter time to response than the incentive group. Our findings suggest that the use of lottery tickets as incentives to increase participation in a mail questionnaire among parents may be less valuable or even harmful. Incentives may undermine motivation in studies in which the intrinsic motivation of the respondents is already high.     

Does non-responder bias have a significant effect on the results in a postal questionnaire study?

Background and aim: In epidemiological questionnaire studies results can be influenced by non-responder bias. However, in respiratory epidemiology this has been analysed in very few recently published papers. The aim of our paper is to assess if the results found in our previous postal questionnaire study in an adult population in Northern Finland were biased by non-response. Methods: A random sample of 385 persons from the 1284 non-responders in a previous postal questionnaire study was examined. The same questionnaire as in the original study was again mailed to these persons, and those still not answering were contacted by phone. Results: Totally 183 complete answers (48%) were collected. Lack of interest (56%) and forgetting to mail the response letter (22%) were the most common reasons to non-response. Typical non-responders were young men and current smokers who less frequently reported respiratory symptoms in exercise and asthma than the responders in the original study. Answers collected by phone gave for some questions higher prevalence rates than postal answers. Conclusion: Firstly, in this population the response rate (83.6%) in the original study was high enough to provide reliable results for respiratory symptoms and diseases, only the prevalence of current smoking was biased by non-response. Secondly, the methods used for collecting responses in a non-response study may influence the results.     

A randomized controlled trial comparing three invitation strategies in a breast cancer screening program

BACKGROUND: The objective of this study was to compare the response received by a population-based breast cancer screening program, according to three different invitation strategies: letters sent by mail from the program (program group), letters sent by mail from the Primary Health Care Team (PHT group), and direct contact through a trained professional (direct contact group). METHODS: We used a cluster-randomized controlled trial with assignment to invitation group using home address. Nine hundred eighty-six women of Barcelona (Spain), ages 50 to 64 years, were invited to participate in the program. The main outcome used was the response rate after the first invitation. RESULTS: Five hundred sixty-four women accepted the invitation (57.2%). The highest response rate was achieved in the direct contact group (63.5%), followed by the PHT group (55.6%), the program group being the one that attained the lowest response rate (52.1%). The direct contact group had a higher probability of participating than the PHT group (RR = 1.14, P = 0.037) or the program group (RR = 1.22, P = 0.003). The response rate in the direct contact group was 72.1% when the letter was received by the subject herself. The increase in response occurred particularly among women of lower educational level. CONCLUSIONS: Inviting women to participate in a breast cancer screening program through direct contact by trained personnel increased participation rate compared with mailed-letter methods. The positive effect appeared restricted to women with lower educational levels.     

Imputing nonresponses to mail-back questionnaires

Many mail-back questionnaires are expected at the outset to elicit poor response rates, perhaps as low as 15-30%. Corrections can be designed into such a survey by using either two or three mailouts of the questionnaire at regular intervals. Assuming a trend in responses as a function of the number of mailouts a person receives before filling out and mailing back the questionnaire, responses are imputed for those who do not mail back the questionnaire after the final mailout. Standard errors are derived, and an example is included. The imputation is easily programmed. A validation of this method is also included.     

A randomized trial of the impact of certified mail on response rate to a physician survey, and a cost-effectiveness analysis

This study's goals were to (a) determine whether sending a survey by certified mail results in a higher response rate from physicians compared to sending by first-class mail and (b) evaluate the cost-effectiveness of this method. The study sample was 409 physicians who were nonrespondents to two previous mailings of a medical specialty society survey. Eligible physicians were designated at random to receive a final mailing either by U.S. Postal Service certified mail including a return-receipt postcard or by first-class mail. There was a higher response rate from the certified mail group compared with the first-class mail group (41.3% versus 24.8%; relative risk = 1.66, 95% Confidence interval 1.25, 2.21). A cost-effectiveness analysis showed that the cost per respondent was higher using certified mail versus first-class mail in the third mailing ($2.77 versus $2.34). Thus, use of certified mail is effective in increasing survey response but more costly.