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Open Access Highly Accessed Research article

Do incentives, reminders or reduced burden improve healthcare professional response rates in postal questionnaires? two randomised controlled trials

Liz Glidewell12*, Ruth Thomas2, Graeme MacLennan2, Debbie Bonetti3, Marie Johnston4, Martin P Eccles5, Richard Edlin6, Nigel B Pitts3, Jan Clarkson3, Nick Steen5 and Jeremy M Grimshaw7

Author Affiliations

1 Leeds Institute of Health Sciences, University of Leeds, Leeds, UK

2 Health Services Research Unit, University of Aberdeen, Aberdeen, UK

3 Dental Health Services Research Unit, University of Dundee, Dundee, UK

4 College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK

5 Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK

6 School of Population Health, University of Auckland, Auckland, New Zealand

7 Clinical Epidemiology Programme, Ottawa Health Research Institute and Department of Medicine, University of Ottawa, Ottawa, Canada

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BMC Health Services Research 2012, 12:250  doi:10.1186/1472-6963-12-250

Published: 14 August 2012

Abstract

Background

Healthcare professional response rates to postal questionnaires are declining and this may threaten the validity and generalisability of their findings. Methods to improve response rates do incur costs (resources) and increase the cost of research projects. The aim of these randomised controlled trials (RCTs) was to assess whether 1) incentives, 2) type of reminder and/or 3) reduced response burden improve response rates; and to assess the cost implications of such additional effective interventions.

Methods

Two RCTs were conducted. In RCT A general dental practitioners (dentists) in Scotland were randomised to receive either an incentive; an abridged questionnaire or a full length questionnaire. In RCT B non-responders to a postal questionnaire sent to general medical practitioners (GPs) in the UK were firstly randomised to receive a second full length questionnaire as a reminder or a postcard reminder. Continued non-responders from RCT B were then randomised within their first randomisation to receive a third full length or an abridged questionnaire reminder. The cost-effectiveness of interventions that effectively increased response rates was assessed as a secondary outcome.

Results

There was no evidence that an incentive (52% versus 43%, Risk Difference (RD) -8.8 (95%CI −22.5, 4.8); or abridged questionnaire (46% versus 43%, RD −2.9 (95%CI −16.5, 10.7); statistically significantly improved dentist response rates compared to a full length questionnaire in RCT A. In RCT B there was no evidence that a full questionnaire reminder statistically significantly improved response rates compared to a postcard reminder (10.4% versus 7.3%, RD 3 (95%CI −0.1, 6.8). At a second reminder stage, GPs sent the abridged questionnaire responded more often (14.8% versus 7.2%, RD −7.7 (95%CI −12.8, -2.6). GPs who received a postcard reminder followed by an abridged questionnaire were most likely to respond (19.8% versus 6.3%, RD 8.1%, and 9.1% for full/postcard/full, three full or full/full/abridged questionnaire respectively). An abridged questionnaire containing fewer questions following a postcard reminder was the only cost-effective strategy for increasing the response rate (£15.99 per response).

Conclusions

When expecting or facing a low response rate to postal questionnaires, researchers should carefully identify the most efficient way to boost their response rate. In these studies, an abridged questionnaire containing fewer questions following a postcard reminder was the only cost-effective strategy. An increase in response rates may be explained by a combination of the number and type of contacts. Increasing the sampling frame may be more cost-effective than interventions to prompt non-responders. However, this may not strengthen the validity and generalisability of the survey findings and affect the representativeness of the sample.