Increasing response to a postal survey of sedentary patients - a randomised controlled trial [ISRCTN45665423]

Background

A systematic review identified a range of methods, which can influence response rates. However, analysis specific to a healthcare setting, and in particular, involving people expected to be poor responders, was missing, We examined the effect of pre-warning letters on response rates to a postal survey of sedentary patients whom we expected a low rate of response.

Methods

Participants were randomised to receive a pre-warning letter or no pre-warning letter, seven days before sending the main questionnaire. The main questionnaire included a covering letter and pre-paid return envelope. After seven days, non-responders were sent a reminder letter and seven days later, another reminder letter with a further copy of the questionnaire and return envelope.

Results

627 adults, with a mean age of 48 years (SD 13, range 18 to 78) of whom 69.2% (434/627) were women, were randomised. 49.0% (307/627) of patients were allocated to receive a pre-warning letter and 51.0% (320/627) no pre-warning letter, seven days in advance of posting the main questionnaire. The final response rate to the main questionnaire was 30.0% (92/307) amongst those sent a pre-warning letter and 20.9% (67/320) not sent a pre-warning letter, with an adjusted odds ratio of 1.60 (95% CI 1.1, 2.30).

Conclusions

The relatively low cost method of sending a pre-warning letter had a modest impact on increasing response rates to a postal questionnaire sent to a group of patients for whom a low response rate was anticipated. Investigators should consider incorporating this simple intervention when conducting postal surveys, to reduce the potential for nonresponse bias and to increase the study power. Methods other than postal surveys may be needed however when a low response rate to postal surveys is likely.     

Effect of prize draw incentive on the response rate to a postal survey of obstetricians and gynaecologists: A randomised controlled trial. [ISRCTN32823119]

Background

Response rates to postal questionnaires are falling and this threatens the external validity of survey findings. We wanted to establish whether the incentive of being entered into a prize draw to win a personal digital assistant (PDA) would increase the response rate for a national survey of consultant obstetricians and gynaecologists.

Methods

A randomised controlled trial was conducted. This involved sending a postal questionnaire to all Consultant Obstetricians and Gynaecologists in the United Kingdom. Recipients were randomised to receiving a questionnaire offering a prize draw incentive (on response) or no such incentive.

Results

The response rate for recipients offered the prize incentive was 64% (461/716) and 62% (429/694) in the no incentive group (relative rate of response 1.04, 95% CI 0.96 - 1.13)

Conclusion

The offer of a prize draw incentive to win a PDA did not significantly increase response rates to a national questionnaire survey of consultant obstetricians and gynaecologists.     

International Questionnaire Postal Response Rate: An experiment comparing no return postage to provision of International Postage Vouchers - "Coupon-Réponse International"

Background

Previous studies of methods to increase response rates on international postal surveys did not include providing return postage. We provided International Postage Vouchers - "Coupon-Réponse International" to cover this. The objective of this study was to see if these International Postage Vouchers had an effect on response rates.

Methods

Between-groups, randomized, after-only

Results

There was no difference in response rates between the group that received International Postage Vouchers and the group that did not. (p = 0.23)

Conclusion

International Postage Vouchers - "Coupon-Réponse International" have no effect on response rates for international postal surveys.     

Short report: encouraging GPs to complete postal questionnaires--one big prize or many small prizes? A randomized controlled trial

BACKGROUND: Low response rates to surveys are a problem in general practice. There is evidence that offering GPs incentives improves response rates to postal questionnaires. However, there is less evidence about the most effective form of incentive. OBJECTIVE: Our trial aimed to maximize response to a postal questionnaire and to test the most effective form of incentive. METHODS: The study involved a randomized controlled trial of a postal survey RESULTS: The incentive of a lottery for six bottles of champagne generated a response rate of 79%. Furthermore, one chance of six bottles generated 9% more responses than six chances of one bottle. CONCLUSIONS: This study has established that, among incentives for postal questionnaires, one big prize improves the yield more than many small prizes despite the lower odds of winning. It has also confirmed that offering a modest incentive to GPs generates good response rates for postal questionnaires.     

Management of children's urinary tract infections in Dutch family practice: a cohort study

Background

Although cardiovascular prediction rules are recommended by guidelines to evaluate global cardiovascular risk for primary prevention, they are rarely used in primary care. Little is known about barriers for application. The objective of this study was to evaluate barriers impeding the application of cardiovascular prediction rules in primary prevention.

Methods

We performed a postal survey among general physicians in two Swiss Cantons by a purpose designed questionnaire.

Results

356 of 772 dispatched questionnaires were returned (response rate 49.3%). About three quarters (74%) of general physicians rarely or never use cardiovascular prediction rules. Most often stated barriers to apply prediction rules among rarely- or never-users are doubts concerning over-simplification of risk assessment using these instruments (58%) and potential risk of (medical) over-treatment (54%). 57% report that the numerical information resulting from prediction rules is often not helpful for decision-making in practice.

Conclusion

If regular application of cardiovascular prediction rules in primary care is in demand additional interventions are needed to increase acceptance of these tools for patient management among general physicians.     

Maximising Responses to Discrete Choice Experiments

Objective

To identify any differences in response and completion rates across two versions of a questionnaire, in order to determine the trade-off between a potentially higher response rate (from a short questionnaire) and a greater level of information from each respondent (from a long questionnaire).

Methods

This was a randomised trial to determine whether response rates and/or results differ between questionnaires containing different numbers of choices: a short version capable of estimating main effects only and a longer version capable of estimating two-way interactions, provided certain assumptions hold. Best-worst scaling was the form of discrete choice experimentation used. Data were collected by post and analysed in terms of response rates, completion rates and differences in mean utilities.

Results

Fifty-three percent of individuals approached agreed to take part. From these, the response to the long questionnaire was 83.2% and the short questionnaire was 85.1% (difference 1.9%, 95% CI -7.3, 11.2; p = 0.68). The two versions of the questionnaire provided similar inferences.

Discussion/conclusion

This trial indicates that, in a healthcare setting, for this complexity of questionnaire (i.e. four attributes and the best-worst scaling design), the use of 16 scenarios obtained very similar response rates to those obtained using half this number.     

Interviewer BMI effects on under- and over-reporting of restrained eating: evidence from a national Dutch face-to-face survey and a postal follow-up

Objectives

To determine the effect of interviewer BMI on self-reported restrained eating in a face-to-face survey and to examine under- and over-reporting using the face-to face study and a postal follow-up.

Methods

A sample of 1,212 Dutch adults was assigned to 98 interviewers with different BMI who administered an eating questionnaire. To further evaluate misreporting a mail follow-up was conducted among 504 participants. Data were analyzed using two-level hierarchical models.

Results

Interviewer BMI had a positive effect on restrained eating. Normal weight and pre-obese interviewers obtained valid responses, underweight interviewers stimulated under-reporting whereas obese interviewers triggered over-reporting.

Conclusion

In face-to-face interviews self-reported dietary restraint is distorted by interviewer BMI. This result has implications for public health surveys, the more so given the expanding obesity epidemic.     

Availability and structure of primary medical care services and population health and health care indicators in England

Background

It has been proposed that greater availability of primary medical care practitioners (GPs) contributes to better population health. We evaluated whether measures of the supply and structure of primary medical services are associated with health and health care indicators after adjusting for confounding.

Methods

Data for the supply and structure of primary medical services and the characteristics of registered patients were analysed for 99 health authorities in England in 1999. Health and health care indicators as dependent variables included standardised mortality ratios (SMR), standardised hospital admission rates, and conceptions under the age of 18 years. Linear regression analyses were adjusted for Townsend score, proportion of ethnic minorities and proportion of social class IV/ V.

Results

Higher proportions of registered rural patients and patients ≥ 75 years were associated with lower Townsend deprivation scores, with larger partnership sizes and with better health outcomes. A unit increase in partnership size was associated with a 4.2 (95% confidence interval 1.7 to 6.7) unit decrease in SMR for all-cause mortality at 15–64 years (P = 0.001). A 10% increase in single-handed practices was associated with a 1.5 (0.2 to 2.9) unit increase in SMR (P = 0.027). After additional adjustment for percent of rural and elderly patients, partnership size and proportion of single-handed practices, GP supply was not associated with SMR (-2.8, -6.9 to 1.3, P = 0.183).

Conclusions

After adjusting for confounding with health needs of populations, mortality is weakly associated with the degree of organisation of practices as represented by the partnership size but not with the supply of GPs.     

Ökonomische Anreize als Instrumente der Präventionspolitik

Background

There are different approaches for the promotion of preventive measures. Economic incentives represent a possible way to motivate and activate the population to a health-conscious behavior and use of prevention measures.

Aims

This paper describes and discusses two possible economic incentives: Firstly, preventive bonus programs, and secondly, medical savings accounts, a form of personal health savings accounts. Those two approaches are presented and later on critically discussed in terms of their incentives to prevention policy.

Results

It remains still uncertain whether material incentives may improve the health behaviour of the population. Economic incentives can serve as an instrument of prevention policies, but further possibilities which are associated with greater involvement and empowerment of the population need to be considered.     

Should we adjust health education methodology to low-educated employees needs? Findings from Latvia,Poland, Slovenia and Spain

Objectives

The presented study explored health beliefs and experiences as well as health education needs of low-educated employees (LEEs) (incomplete primary, primary, lower secondary and basic vocational education) in comparison to those with higher education (secondary and tertiary education) in four European countries: Latvia, Poland, Slovenia and Spain. The main aim was to identify a specificity of low-educated employees (LEEs) by capturing their opinions, experiences, attitudes and needs concerning health education.

Material and Methods

The sample consisted of 1691 individuals with the status of an employee (approximately 400 respondents in each of 4 countries participating in the project). The respondents were aged 25-54 (both the control group and the target group consisted in 1/3 of the following age groups: 25–34, 35–44 and 45–54). The respondents were interviewed during the years 2009 and 2010 with a structured questionnaire concerning their health, health behaviours as well as educational needs concerning health education.

Results

The study revealed substantial differences in the attitudes of people from this group concerning methodology of health education. LEEs prefer more competitions and campaigns and less written educational materials in comparison to those with higher education. Additionally, they more often perceive a fee, longer time, necessity to take part in a knowledge test and a concern that their health will be checked as factors that can discourage them from taking part in a health training. On the other hand, LEEs can by encouraged to take part in such a training by a media broadcast concerning the event, snacks or lottery during the training, or financial incentives.

Conclusions

The results of the study proved the need for specific health education guidelines to conduct health education for low-educated employees. These guidelines should take in account the sources of health education preferred by LEEs as well as the factors that can encourage/discourage their participation in trainings concerning health.     

Gesundheit und Gesundheitsverhalten bei Beschäftigten an den Universitäten Freiburg und Karlsruhe

Background

Results of two employee surveys at Karlsruhe and Freiburg Universities (Baden-Wuerttemberg, Germany) were evaluated. The comparative approach offered the chance to compare work-related health and health behaviour due to individual and job factors. Another aim of the study was to ascertain the need for health promotion activities in the university setting.

Material and methods

An adapted version of the SALSA questionnaire, with additional questions in Freiburg about preventive health behaviour, was applied in both universities in full-time clerks and technical staff.

Results

Both collectives do not differ significantly in their reported (good) state of health. No greater differences in subjective health and health behaviour could be observed in the different professional groups. The need for future action in health promotion was seen differently in the Karlsruhe and Freiburg samples.

Conclusion

Despite the different response rates the results for Karlsruhe and Freiburg Universities are comparable in most aspects and show positive outcomes. Designating specific health promotion needs should permit the management in both universities to offer appropriate measures and initiate improvements.     

Self-reported health in urban–rural continuum: a grid-based analysis of Northern Finland Birth Cohort 1966

Objectives

To evaluate the association of self-reported health with residential area type defined by the population density in individual??s local environment using a population-based cohort in Finland.

Methods

Young adults of the Northern Finland Birth Cohort 1966 (4,201 women and 3,835 men), surveyed by a postal questionnaire in 1997, were linked to population density of their resident grid (1?km²) depicting different types of residential areas. Self-reported health was regressed on residential area type using ordinal logistic analysis, adjusting for psychosocial well-being, social relationships, health behaviour, education and residence time.

Results

Cumulative odds ratios (COR) for poor health were lowest in high-rise centres, highest in scattered settlement areas and second highest in transitional zones. Adjustments (especially for education and time of residence) reduced the CORs to insignificance except the persistently high COR for women in scattered settlement areas.

Conclusion

Poor self-reported health is associated with individual??s residential area type, with the lowest occurrence in high-rise centres and higher elsewhere. The difference is likely explained, at least partly, by a complex of psychosocial factors, possibly different for women and men.     

A low response rate does not necessarily indicate non-response bias in gastroenterology survey research: a population-based study

Aim

To estimate the potential for response bias in standard mailed questionnaires used in surveys of GI symptoms in a community.

Subjects and methods

Validated self-report tools have been developed to measure functional gastrointestinal (GI) disorders but response rates in community surveys have been rapidly declining in many parts of the world. Whether a lower community response rate introduces significant response bias in GI survey research is unknown. A questionnaire was mailed to a total of 5,069 randomly selected subjects. The overall response rate was 52 %. A random sample of 723 of these subjects (428 responders and 295 non-responders, stratified by age and gender) was selected for medical record abstraction (including both inpatient and outpatient history).

Results

The odds for response increased in those with a higher body mass index (odds ratio (OR):1.02 [95 % CI: 1.01, 1.03]), more health care seeking behavior for non-GI problems (OR: 1.97 [95 % CI: 1.43, 2.72]), and for those who had responded to a previous survey (OR: 4.84 [95 % CI: 2.84, 8.26]). Responder status was not significantly associated with any GI symptoms or a diagnosis of GI or non-GI disease (with two exceptions, diverticulosis and skin disease).

Conclusions

Despite a response rate of only 52 %, the results of a community-based GI survey do not appear to be impacted by non-response bias in a major way. A low survey response rate does not necessarily indicate non-response bias.     

Zugang zu sozial benachteiligten Familien

Background

This study aimed to assess program reach, identify effective recruitment strategies, and explore obstacles to cooperation with other health and social service providers (multipliers) regarding a randomized trial for socially disadvantaged first-time mothers.

Method

A postal multiplier survey (N=361) was conducted.

Results

Seventeen percent of the potential clients were advised to participate in the trial. No significant influence of the information channel on the multipliers’ referral behavior was found in a logistic regression. Thus, no particularly effective communication strategy was identified. Objections to the control group design were the strongest reason hindering multipliers with high contact rates to potential clients to cooperate.

Conclusion

The results underscore the need for intensive discussion between researchers and practitioners about the use of randomized trials in the field of prevention.     

The effects of socio-economic status and physical health on the long-term care needs of Japanese urban elderly: a chronological study

Objectives

The aim of this chronological study was to elucidate the effects of socio-economic status (SES) and physical health on the long-term care (LTC) needs of a Japanese elderly population and to explore their causal relationships.

Methods

A self-administered questionnaire was distributed to all residents aged 65 years and older of Tama City, Tokyo, in September 2001. A total of 13,195 completed questionnaires were returned, giving a response rate of 80.2 %. A follow-up study was done using the same questionnaire in 2004. Ultimately, 7,905 respondents were included in our analysis. Data analysis was performed using correlation analysis and structural equation modeling (SEM). For SEM, we used one observed variable (LTC needs in 2004) and three latent variables (SES in 2001 and physical health in both 2001 and 2004).

Results

The data were well fit by the models, with a NFI of 0.980, CFI of 0.982, and RMSEA of 0.032. LTC needs were well explained by the three latent variables (R ² = 0.70 and 0.66 for elderly men and women, respectively). Among all variables, physical health in 2004 was the strongest determinant of LTC needs, followed by physical health in 2001, and SES in 2001. Gender differences in the structural relationships were minor.

Conclusions

Our results indicate that good physical health directly contributes to reducing LTC needs among Japanese elderly. In addition, efforts to increase income and educational levels may help to decrease LTC needs by indirectly improving physical health.     

Gesundheitsberichterstattung bei Studierenden

Objective

Little research has been done on student health in Germany. High well-being scores but risky health behaviors (e.g., substance use) have been stated but are often not linked with the university context.

Method

To promote health assessment in Germany that includes the university context, empiric research was reviewed.

Results

Best-practice models are based on theoretical models that integrate health indicators as well as personal and university conditions. To assess stress and resources in the university context, new questionnaires were developed and evaluated. Positive and negative aspects of health and personal circumstances were measured by established questionnaires.

Conclusions

To promote the health assessment of college students in Germany, the development of instruments and data-based interventions should be continued.     

Verhaltenstherapeutische Raucherentwöhnung in der GKV

Background and methods

Behavioural smoking cessation courses can be provided and reimbursed by German health insurance funds according to § 20 SGB V or § 20a SGB V. The aim of this study is to analyse the supply and reimbursement conditions for these measures. The study was conducted as a cross-sectional postal survey of all compulsory health insurance funds (n=219).

Results

The survey response rate was 45% (n=98). Over 90% of respondent health insurance funds provide internal or external behavioural (mostly group-based) smoking cessation courses according to § 20 SGB V. The reimbursement rates vary between 80 and 100% (maximum of 75–150 euros). Internal courses are associated with higher reimbursement rates and limits. Approximately one third of surveyed insurance funds also provide telephone- and Internet-based services concerning smoking cessation. Furthermore, the majority of sickness funds is active in the field of smoking cessation according to § 20a SGB V (workplace health promotion).

Conclusions

Most of the German insurance funds provide behavioural-based smoking cessation courses with high or full cost coverage. International experiences show that cost reimbursement can lead to higher demand for tobacco cessation services and quit rates. In the light of available evidence regarding the effectiveness and cost-effectiveness, existing courses (in combination with cessation aids) should be evaluated with high-quality health economic studies.     

Resource use data by patient report or hospital records: Do they agree?

Background

Economic evaluations alongside clinical trials are becoming increasingly common. Cost data are often collected through the use of postal questionnaires; however, the accuracy of this method is uncertain. We compared postal questionnaires with hospital records for collecting data on physiotherapy service use.

Methods

As part of a randomised trial of orthopaedic medicine compared with orthopaedic surgery we collected physiotherapy use data on a group of patients from retrospective postal questionnaires and from hospital records.

Results

315 patients were referred for physiotherapy. Hospital data on attendances was available for 30% (n = 96), compared with 48% (n = 150) of patients completing questionnaire data (95% Cl for difference = 10% to 24%); 19% (n = 59) had data available from both sources. The two methods produced an intraclass correlation coefficient of 0.54 (95% Cl 0.31 to 0.70). However, the two methods produced significantly different estimates of resource use with patient self report recalling a mean of 1.3 extra visits (95% Cl 0.4 to 2.2) compared with hospital records.

Conclusions

Using questionnaires in this study produced data on a greater number of patients compared with examination of hospital records. However, the two data sources did differ in the quantity of physiotherapy used and this should be taken into account in any analysis.