Increasing the response rates of reluctant professionals to mail surveys.
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Bias↗
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Comparison of methods for collection of DNA samples by mail in the Black Women's Health Study.
PURPOSE: The authors compared approaches to participants and methods of collecting buccal cell samples by mail in the Black Women's Health Study, a follow-up study of geographically dispersed African-American women. Outcomes of interest were within group participation rates, yield of DNA, and PCR success. METHODS: Six hundred fifty six participants were randomized to four groups: Groups 1 and 2 used the cheek swab method and Groups 3 and 4 used the mouthwash swish method. Groups 1 and 3 were mailed collection kits together with consent forms, whereas Groups 2 and 4 were mailed a kit only after returning a signed consent. RESULTS: Participation rates were similar regardless of the method used for sample collection or mailing of the kits: samples were returned by 40% of Group 1, 37% of Group 2, 36% of Group 3, and 35% of Group 4. The median DNA yield was 3693 ng/sample for the swab method and 10,077 ng/sample for the mouthwash swish method (p<0.001). PCR analyses were successful in 98% of mouthwash samples and 94% of swab samples. CONCLUSION: Because of its higher yield of DNA, the mouthwash swish method is preferable for collection of buccal cell samples by mail.
Adult↗
Effects on subject response of information brochures and small cash incentives in a mail-based case-control study.
PURPOSE: To investigate the impact on subject response of an information brochure and cash incentives included with mailed questionnaires in case-control studies. METHODS: A randomized trial was carried out within a case-control study investigating cancer in the Province of Ontario. Brochures were included with half of the mailed questionnaires sent to 7487 cases and 2561 controls. Controls were also sent cash incentives of $2, $5, or no money. RESULTS: With the brochure, response changed from 75.0% to 75.8% in cases, and from 70.3% to 71.1% in controls. Adjusting for differences in age, residence, sex, and cancer site/status, the change was 0.2% [95% confidence interval (CI) = -1.7-2.1] in cases, and 0.6% (95% CI = -3.1-4.3) in controls. The $2 and $5 incentives increased overall response in controls from 61.9% to 72.8% and 77.2%, respectively, i.e., by 10.9% (95% CI = 6.1-15.6) and 15.1% (95% CI = 10.4-19.7), after adjustment. This effect was largely confined to urban areas (for $2 and $5, respectively: 5.5% and 14.2% in Toronto, 15.3% and 20.4% in other urban areas vs. 2.7% and 1.0% in rural areas; p = 0.02). Response time showed little or no improvement when the brochure was included, but was markedly reduced for both the $2 and $5 incentives. CONCLUSIONS: Cash incentives can improve subject response in epidemiologic studies, whereas information brochures do not appear to have an effect.
Adult↗
Improving the pneumococcal immunization rate for patients with diabetes in a managed care population: a simple intervention with a rapid effect.
BACKGROUND: Pneumococcal disease kills more people in the United States than any other vaccine-preventable bacterial disease, and a national health objective for the year 2000 is that at least 60% of eligible persons be immunized with pneumococcal vaccine. METHODS: An electronic care monitoring system was used to track immunization of patients with diabetes in a managed care plan who were receiving their care through a staff-model primary care clinic in Guam. In November 1998 a letter was sent to all patients not known to be immunized. The letter invited these patients to attend immunization clinics and waived usual copayment. Standing orders were also created for the clinic nurses to administer pneumococcal vaccines. In addition, a diabetes care status report was placed on each patient's medical record. RESULTS: The immunization rate for the 1,278 actively enrolled patients with diagnosed diabetes increased from 42% in October 1998 to 62% in January 1999. Compared to November 1995, 1996, and 1997, the number of pneumococcal immunizations increased more than 15-fold in November 1998. DISCUSSION: The combined use of patient outreach letters, special immunization clinics, standing orders, and practitioner reminders on medical records resulted in a rapid, marked increase in the pneumococcal immunization rate for patients with diabetes. The electronic care monitoring system is being used to target get interventions for improvement opportunities for an array of diabetes care measures, including regular foot care and eye exams.
Adult↗
Evaluating the results of mail survey research.
OBJECTIVE: To present overall guidance enabling the reader to critically evaluate survey research conducted via mail questionnaire. Also considered are the sources of error that may operate during the conduct of survey research and the threats they pose to both the internal rigor of the study and the generalizability of the results. STUDY SELECTION: Not applicable. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: Not applicable. CONCLUSION: Survey research has been used so commonly and for such a wide range of purposes in a large number of fields, that some people may mistakenly conclude that surveys are easy to conduct. Survey research involves much more than generating a set of questions to ask a group of subjects. To draw valid conclusions about the topic of a survey, the pharmacist must be prepared to evaluate the results in light of how well the investigators approached four sources of error--coverage, sampling, measurement, and nonresponse. The evaluation of survey administration procedures primarily concerns determining whether or not a pilot study was conducted, whether proper statistical analyses were conducted, and whether multiple mailing procedures were used. Failure to account for these sources of error, or inappropriate survey administration, could seriously affect both the generalizability and validity of the results.
Data Interpretation, Statistical↗
Twin zygosity diagnosis by mailed questionnaire below age twelve months. Le Groupe Romulus.
Parents of a sample of 76 same sexed pairs of twins aged 3 to 9 months completed a mailed similarity questionnaire. It included the Bonnelykke et al.'s questionnaire and a four anthropological variable scale. To improve each of these two methods, three other combined methods were carried out and results were compared with the biological zygosity diagnosis. The Bonnelykke et al.'s classification combined with anthropological scale (method 4) gave only 1.2% misclassified in the whole sample. It is concluded that zygosity diagnosis using this type of procedure to distinguish MZ and DZ pairs would be important not only for epidemiological study but also for pediatricians and parents.
Humans↗
Accuracy of postal questionnaires?
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Data Collection↗
Accuracy of postal questionnaires.
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Directories as Topic↗
Cost-effectiveness analysis of a complementary health intervention: the case of smoking relapse prevention.
OBJECTIVES: We assess the cost-effectiveness of smoking relapse prevention interventions designed to keep quitters from resuming the use of cigarettes. Because relapse prevention is complementary to smoking cessation efforts, the appropriate test of its cost-effectiveness is whether it reduces the incremental cost-effectiveness ratio (ICER) of smoking cessation. The major goal of the study is to carry out such a test. METHODS: Data from a randomized trial that ascertained the effectiveness of alternative modes of smoking relapse prevention are combined with ICER estimates of smoking cessation to assess whether relapse prevention is cost-effective. RESULTS: The trial produced convincing evidence that relapse prevention yields statistically significant reductions in the proportion of quitters who are smoking at 24 months postquit. The intervention effects are substantial enough to raise the denominator terms of the smoking cessation ICER and, thereby, offset the amount relapse prevention adds to cost numerator terms. In this sense, smoking relapse prevention tends to pay for itself. CONCLUSIONS: Smoking relapse prevention is a highly cost-effective addition to current efforts to curb cigarette consumption. Complementary health interventions of this sort should be assessed by different methods than those commonly found in the cost-effectiveness literature.
Adolescent↗
Dose-response in an outbreak of non-bacterial food poisoning traced to a mixed seafood cocktail.
An outbreak of non-bacterial food poisoning presumed due to small round, structured viruses (SRSV) occurred at a national conference. A detailed postal survey of all conference attenders was carried out to ascertain the cause of the outbreak and 355 questionnaires were returned. Univariate analysis showed that mussels in the seafood cocktail were the likely vehicle of infection. A dose-response relationship between the amount of seafood cocktail consumed and the risk of illness was demonstrated. Dose-response has not previously been documented in a food-borne outbreak due to small round structured virus. Detailed quantitative food histories can be useful in eliciting dose-response relationships and may be crucial in establishing the vehicle of infection when investigating food poisoning following consumption of a set-menu meal. Their use should be considered in other outbreak situations.
Disease Outbreaks↗
A novel method of oral fluid collection to monitor immunity to common viral infections.
Serological surveys among representative population samples have proved rare given their reliance on invasive sample collection. We therefore completed the first population-based postal survey of immunity in England and Wales using new oral fluid technology. This paper examines the feasibility of this new methodological approach. Nearly 5500 oral fluid samples were collected, with individual demographic and social data via a questionnaire, from persons under 45 years of age recruited through general practices. Instructions were accurately followed with only 1% of samples returned without risk-factor data. The overall response rate was 40%. Response was independently associated with age, sex and location. Response was highest in children aged 5-14 years, adult females and in rural locations. This approach allowed the successful collection of comprehensive individual risk data, but response rates in adults must be improved if oral fluid surveys are to routinely complement serological surveillance.
Adolescent↗
The effect of follow-up on limiting non-participation bias in genetic epidemiologic investigations.
The use of a comprehensive follow-up strategy to limit non-participation bias was evaluated in a population-based case-control study of orofacial clefts. Birth parents were requested to provide exposure data, and index children and parents were asked to provide blood specimens. Follow-up included telephone or postal reminders every two weeks for up to three months. Consent to participate was received from 281 (76.6%) case mothers and 246 (72.4%) case fathers. The corresponding totals for controls were 279 (54.7%) and 245 (49.8%). Evaluation of participation rates by intensity of follow-up showed that 23% of case and 18% of control families consented without reminders (first stage); 81% of cases and 83% of controls agreed following one or two reminders (second stage); and the remainder of participants consented following three or more reminders (final stage). Cumulative distributions of sociodemographic characteristics differed little between second and final stage participants. Odds ratios for maternal multivitamin use were similar between second and final stage participants, whereas those for maternal and paternal smoking tended to decline. Although follow-up measures were necessary to enroll most families, use of more than two reminders did not appear to increase the representativeness of the sample; however, termination of recruitment after only two reminders would have led to different conclusions. Future studies require data collection protocols that encourage participation from all population subgroups, and one alternative is presented.
Adult↗
The problem of measuring change in individual health-related quality of life by postal questionnaire: use of the patient-generated index in a disabled population.
The Patient-generated Index (PGI) is a health-related quality of life (HRQoL) measure which asks respondents to nominate the areas of their lives which are most affected by their health condition, so that they can then rate the severity of the effects and weight their relative importance. It is unusual amongst such measures in that it is designed for postal administration. This study assessed the ability of the revised PGI to measure change in HRQoL in a population of 161 people who had previously been identified as having limiting long-term illness. A questionnaire, including a revised version of the PGI and the developmental version of the SF-36, was mailed at two time points (T1 and T2), 4.5 months apart. The PGI was subsequently assessed in terms of practicality, validity, reliability and responsiveness. At T1, 62% of those who felt that they still had a health problem affecting their life completed the PGI correctly. These people were significantly younger and had spent longer in education than the remaining 38%. Only 19 respondents completed the PGI correctly on both occasions, rendering reliability and responsiveness testing inconclusive. The value of the PGI is significantly diminished by the fact that many people cannot complete it correctly. Future development of the instrument is appraised in the context of related measurement methods.
Activities of Daily Living↗
The impact of different response alternatives on responders' reporting of health-related behaviour in a postal survey.
Previous experimental research in other topic areas has shown that the choice of response alternatives can influence respondents' reporting of the frequency of vaguely defined events and that the set of response alternatives is treated as information in the interpretation of the question. The aim of this study was to examine whether such affects would occur in the context of respondents reporting of health-related events using high and medium frequency closed format response categories, which might be used interchangeably by researchers. The study consisted of a postal survey of n = 518 patients aged > or = 18 years randomly selected from the patient list of a diabetes centre and who were equally and randomly allocated to one of three conditions (Condition A: high frequency response alternatives/horizontal orientation; condition B: medium frequency response alternatives/horizontal orientations; condition C: high frequency response alternatives/vertical orientation). Testing for the effect of response alternatives for the combined responses of five vaguely defined questions between conditions A and B was chi 2 = 5.5, p = 0.019, for the difference in proportions, indicating that overall, those respondents presented with response alternatives discriminating at medium frequency, reported significantly fewer target events than those presented with high frequency response alternatives. Testing for the effect of orientation of the combined question responses between conditions A and C, differences in proportions between conditions, did not reach statistical significance (p > 0.05). Findings from this and previous studies indicate that response alternatives provide information on the interpretation of vaguely defined questionnaire items and that their choice should not be left to intuition alone when designing questionnaire items.
Adult↗
Nurses' perceptions of complementary and alternative medical therapies.
The purpose of this study was to identify the perceptions of nurses toward the effectiveness and safety, as well as their recommendations for and personal use of complementary and alternative medical therapies. A, random sample of 1000 nurses throughout the United States were surveyed using a three-wave mailing. About half of the respondents perceived there was conclusive evidence or preponderance of evidence that five therapies were effective: biofeedback, chiropractic, meditation/relaxation, multi-vitamins, and massage therapy. The same amount of nurses also perceived five therapies as definitely safe: hypnotherapy, chiropractic, acupressure, acupuncture, and healing touch. However, the nurses were most likely to recommend (regularly or periodically) four therapies: multivitamins, massage, meditation/relaxation, and pastoral/spiritual counseling. The vast majority (79%) of nurses perceived their professional preparation in this area to be fair or poor.
Adult↗
The effects of mailed reminders and tailored messages on mammography screening.
A mail campaign to promote mammography screening was tested with 3,887 Medicare recipients in North Dakota who had not had a mammogram in 2 1/2 years. Three types of mailings were compared: (1) a simple reminder message, (2) a reminder accompanied by a persuasive communication emphasizing personal risk, and (3) a reminder accompanied by a message tailored to the participants' chief barrier to having a mammogram. Overall, subsequent mammography rates for women in these conditions did not differ from the rate observed among women who did not receive any mailing. However, post-hoc analyses suggested that women who reported a barrier to having a mammogram were more likely to have a mammogram. Population-wide mail campaigns of the kinds tested here may be generally ineffective for Medicare recipients who are obtaining screenings infrequently. Tailoring messages may be one potentially effective intervention, if investigators can develop ways to increase responses to inquiries about barriers.
Aged↗
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 1,284 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.
Adult↗
DNA from buccal swabs recruited by mail: evaluation of storage effects on long-term stability and suitability for multiplex polymerase chain reaction genotyping.
We provide details of an inexpensive and rapid method for extraction of DNA from buccal swabs (including samples received through the mail) and from a range of other tissue samples. The procedure we have developed provides amounts of DNA adequate for several thousand polymerase chain reactions (PCRs), and we have validated its potential for long-term storage. Samples stored for > 4 years are of comparable concentration and provide as robust PCR templates as those tested immediately after extraction. The availability of this technology is of considerable significance in planning DNA banks from population collections and cohorts.
Cheek↗