Effects of mailing strategies on response rate, response time, and cost in a questionnaire study among nurses

We conducted a pilot study to determine the most efficient mailing strategy for a postal questionnaire study among nurses in Ontario, Canada. Five mailing strategies involving types of stamps on the return envelopes were considered: no stamp, business-reply stamp, metered stamp, small regular stamp, and large commemorative stamp. We found that paper stamps, especially large commemorative stamps, on return envelopes increased the response rate and reduced the response time, as compared with other mailing strategies. Business-reply stamps had the lowest cost per response received and a low total cost.     

The effect of a monetary incentive in increasing the return rate of a survey to family physicians

The barrage of requests family physicians receive to complete mail surveys often results in physicians who are unwilling, or unable due to time constraints, to complete each survey they receive. Thus, to obtain an acceptable response rate, state-of-the-art mail survey techniques must be used. This article reports the results of the use of a modest ($1) monetary incentive to increase a survey response rate. A random sample of 600 American Academy of Family Physicians members were mailed a survey of firearm safety counseling; half received a $1 incentive whereas the remaining half served as a control group. The response rate in the incentive group was 63% compared to 45% in the control group [chi 2 (1, N = 251) = 16.0, p < .001]. Further, the use of the incentive appears to be more cost-effective than a third follow-up (postcard reminder) mailing.     

Questionnaire order significantly increased response to a postal survey sent to primary care physicians

OBJECTIVE: Primary care physicians are increasingly being asked to participate in postal surveys. Difficulties in achieving adequate response rates among physicians have been reported. We investigated the effect of two low-cost interventions on response to a primary care physician postal questionnaire. STUDY DESIGN AND SETTING: A 2x2 factorial trial was developed within the context of a national survey assessing views and practices of physicians regarding prostate-specific antigen testing. We evaluated questionnaire order (version 1: demographics first, version 2: topic-specific questions first) and written precontact. A national database of primary care physicians was compiled. One thousand five hundred ninety-nine physicians were randomly selected, stratified by health board, and randomized. RESULTS: 47.9% of eligible physicians completed a questionnaire. There was a statistically significant 5.1% higher response rate among physicians receiving version 1 of the questionnaire than those receiving version 2 (50.6% vs. 45.4%, P=0.05); the adjusted odds of response were significantly raised (odds ratio=1.24; 95% confidence interval=1.01-1.54). Precontact resulted in a nonsignificant 3.6% increase in response (49.8% vs. 46.2%; P=0.16). The interventions did not interact. CONCLUSION: Ordering questionnaires with general questions first can significantly increase response rates, whereas precontact can achieve a modest increase. These strategies may enhance response while adding little to the cost of a physician survey.     

Labour-saving strategies to maintain survey response rates: a randomised trial

To evaluate response-aiding strategies feasible in large surveys, we randomly allocated general practitioners (GPs) to one of four intervention groups: Group 1 received 'exhaustive' telephone prompts by a medical peer in advance of a questionnaire; Group 2, inclusion of an embossed pen with the questionnaire; Group 3, an advance letter prompt; and Group 4, a 'single attempt' advance telephone prompt by a non-medical research assistant. Follow-up procedures were identical. Response rates by group were not significantly different overall (χ²4.59, df=3, p=0.20) although advance prompts by a medical peer were significantly more effective than other strategies for male GPs. The difference in overall response rates between males (63%) and females (74%) was significant (χ²=15.40, df=1, p<0.01). No other response bias was evident. Our demonstration of a significant interaction between respondent sex and response-aiding strategy invites further research.     

The effect of question preface on response rates to a telephone survey of sexual experience

Given the heavy reliance on self-report measures in research on sexuality, issues surrounding nonresponse rates are of particular importance. Phone interviews were conducted with 400 adults living in a midsized midwestern city. Rates of nonresponse and reported sexual experience were analyzed as a function of the type of preface statement provided for four questions related to sexual behavior. One preface was general; the other referred to public concern over AIDS. On questions regarding number of sexual partners in the past year and involvement in extramarital sex, women who were given the AIDS preface were significantly more likely to answer the questions than were women who received the general preface. However, for both men and women, reported rates of sexual experience did not differ as a function of the preface statement. Differences between responders and nonresponders were explored. Men were more likely to respond to the sexual items. Education, age, marital status, and religious affiliation were unrelated to rates of response to the sexual questions. For men, responders to the sexuality items reported greater yearly incomes than did nonresponders. Some differences in reported sexual behavior were also found between responders and nonresponders; nonresponders consistently reported less sexual experience. Implications for research on sexuality and future investigation of factors affecting response to sexual items are discussed.     

Effectiveness of various mailing strategies among nonrespondents in a prospective cohort study

Measures of association in prospective studies can be distorted by incomplete follow-up. Various mailing strategies were used to contact 12,233 cohort members of the Health Professionals Follow-up Study who had not responded to three successive bulk-rate mailings. Response rates were highest, 79.5% overall, from participants who were sent a certified mailing in phase 1 (63.2%), followed by a repeat certified mailing to nonrespondents (44.3%). Although altering the physical appearance of the envelope and using other postal rates were tested, certified mail was the most effective approach for reaching study members who were nonrespondents to a mailed questionnaire.     

Factors influencing identification of and response to intimate partner violence: a survey of physicians and nurses

Background  

Intimate partner violence against women (IPV) has been identified as a serious public health problem. Although the health care system is an important site for identification and intervention, there have been challenges in determining how health care professionals can best address this issue in practice. We surveyed nurses and physicians in 2004 regarding their attitudes and behaviours with respect to IPV, including whether they routinely inquire about IPV, as well as potentially relevant barriers, facilitators, experiential, and practice-related factors.     

Interviewing physicians: the effect of improved response rate.

This analysis of data from the Physicians' Practice Survey indicates that estimates made from early responders closely approximate those obtained at the conclusion of a longer field period.     

Effects of incentives and prenotification on response rates and costs in a national web survey of physicians

Little is known about what strategies are cost-effective in increasing participation among physicians in surveys that are conducted exclusively via the web. To assess the effects of incentives and prenotification on response rates and costs, general internists (N = 3,550) were randomly selected from the American Medical Association (AMA) Masterfile and assigned to experimental groups that varied in the amount of a promised incentive (none, entry into a $200 lottery, $50, or $100) and prenotification (none, prenotification letter only, or prenotification letter containing a $2 preincentive). Results indicated that the response rates were highest in the groups promised $100 and $50, respectively. While the postal prenotification letter increased response rates, the inclusion of a small token $2 preincentive had no effect on participation. Further, unlike mail surveys of physicians, the $2 preincentive was not cost-effective. Among physicians, larger promised incentives of $50 or $100 are more effective than a nominal preincentive in increasing participation in a web-only survey. Consistent with prior research, there was little evidence of nonresponse bias among the experimental groups.     

Prescribing CPR: a survey of physicians.

We interviewed 55 cardiologists, internists, and family practitioners to determine attitudes and practices regarding cardiopulmonary resuscitation (CPR) counseling. There was unanimous support for citizen-CPR. However, only 40 per cent of the physicians interviewed recommended CPR training to spouses of patients with coronary heart disease and 42 per cent did not provide counseling about cardiac arrest. This suggests that the doctor's office can be better utilized in the promotion of CPR education.     

Nonresponse bias in a mail survey of physicians

With the increased pressure on survey researchers to achieve high response rates, it is critical to explore issues related to nonresponse. In this study, the authors examined the effects of nonresponse bias in a mail survey of physicians (N = 3,400). Because slightly more than one half of the sample did not respond to the survey, there was potential for bias if nonresponders differed significantly from responders with respect to key demographic and practice variables. They analyzed response status and timing of response with respect to five variables: gender, region, specialty, urbanicity, and survey length. The potential consequences of nonresponse bias on the survey estimates were then analyzed. Men were more likely to respond, as were physicians receiving a shorter questionnaire. Repeated follow-up attempts reduced gender response bias because male physicians were more likely to be early responders. Overall, higher response rates were not associated with lower response bias.     

Temporary physicians can be key to hospital strategies

When a physician staffing crisis occurs, hospitals often turn to services specializing in placing interim doctors, or locum tenens. But these docs can do more than fill an emergency need; they can be used for some strategic purposes such as test marketing a new physician service, assisting during peak periods and broadening recruitment guidelines. Wanda Dearth, who heads an interim physician staffing firm in Irving, Texas, offers some advice.     

Caffeine,cajoling, and other strategies to maximize clinician survey response rates

An ongoing objective in health services research is to increase response rates to clinician surveys to ensure generalizability of findings. Three HMOs in the Cancer Research Network participated in a primary care clinician survey to better understand organizational characteristics affecting adoption and implementation of breast and cervical cancer screening guidelines. A four-stage data collection strategy was implemented to maximize response. This included careful attention to survey design and layout, extensive piloting, choice of token incentive, use of "local champions," and denominator management. An overall response rate of 91% was attained, ranging from 83 to 100% among the plans (N = 621). Although the response rate after the second stage of data collection met commonly used standards, the authors argue for the four-stage method due to the possibility of differences when comparing early and late responders. This is important when multiple plans with differing structure and internal characteristics are surveyed.     

The requirement for prior consent to participate on survey response rates: a population-based survey in Grampian

Background  

A survey was carried out in the Grampian region of Scotland with a random sample of 10,000 adults registered with a General Practitioner in Grampian. The study complied with new legislation requiring a two-stage approach to identify and recruit participants, and examined the implications of this for response rates, non-response bias and speed of response.     

The providers of health services in Lebanon: a survey of physicians

Background  

Emerging from civil distress carries with it major challenges to reforming a health system. One such challenge is to ensure an adequate supply of competent human resources. The objective of this study was to assess the supply of physicians in Lebanon in 1998, with an assessment of their practice patterns and capacity building.