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PubMed1979

Physician response rates to mail and personal interview surveys.

This paper reports the outcome of a randomized experiment, sponsored by the Food and Drug Administration, which compares mail and personal administration of a 12-page questionnaire dealing with physician antibiotic prescription practices. To overcome the barrier created by the lack of clearly defined and accepted definitions of survey outcomes, the authors introduce six concepts for describing and comparing survey outcomes. Overall, mail surveys appear to require less time, to be less costly, and to generate higher response rates than equivalent personal contacts. The report describes methods for gaining maximum benefit from the mail technique.

Anti-Bacterial Agents↗
PubMed2002

Reliability of postal questionnaires for the Glasgow Outcome Scale.

The purpose of the study was to investigate if a questionnaire sent by mail can give a reliable assessment of outcome on the Glasgow Outcome Scale. A questionnaire was developed for the Glasgow Outcome Scale (GOS) and a second questionnaire for the Extended Glasgow Outcome Scale (GOSE). The questionnaires were self-contained and designed to be completed by either a head-injured person or a proxy. The questionnaires were studied in two ways: each questionnaire was administered twice (at an interval of approximately 2 weeks), and ratings from the postal questionnaires were compared to ratings from a structured interview conducted by telephone. The four studies were carried out in separate groups of head-injured participants consisting of 32-38 individuals. For the test-retest comparison, k(w) (quadratic weights) was 0.94 for the GOS questionnaire and 0.98 for the GOSE questionnaire. For the comparison with the telephone interview, k(w) was 0.67 for the GOS and 0.92 for the GOSE. The values of k(w) indicate good agreement for all comparisons. We conclude that it is possible to obtain reliable outcome data after head injury using postal questionnaires.

Adolescent↗
PubMed2004

A bitter pill to swallow: nonadherence with prophylactic antibiotics during the anthrax attacks and the role of private physicians.

To generate recommendations for improving adherence to public health advice during public health crises, we conducted semi-structured interviews with employees at the Brentwood Road Postal Facility and on Capitol Hill to identify key themes associated with decisions to adhere to recommended antibiotic prophylaxis during the 2001 anthrax attacks. Factors used in deciding to adhere to recommended prophylactic antibiotics and concerns about the official response were similar in Brentwood and Capitol Hill employees, and in adherent and nonadherent participants. All participants used multiple sources of information and support as they weighed the risk from anthrax against the advantages and disadvantages of antibiotics. We found that nonadherent participants were commonly following the advice of private physicians, whereas adherent participants commonly described ongoing support from multiple sources when discussing their decisions. Our findings highlight the need for better integration between the public and private health care systems during public health crises and the importance of equipping private physicians for their key role in aiding decision-making during a public health crisis. Special attention also should be given to enhancing support and information from multiple sources throughout the entire period of risk.

Anthrax↗
PubMed2005

Remediation of Bacillus anthracis contamination in the U.S. Department of Justice mail facility.

The U.S. Department of Justice (DOJ) mail facility in Landover, Maryland, was contaminated with Bacillus anthracis spores as a result of the 2001 anthrax bioterrorism attacks through the U.S. postal system. Surface environmental sampling within the facility indicated that the contamination was due to receipt of mail that had come in contact with Bacillus anthracis spores from the source letters at the Brentwood postal facility in Washington, DC. The DOJ adopted a two-pronged approach for remediating the facility, using aqueous chlorine dioxide to decontaminate hard, nonporous surfaces and paraformaldehyde to fumigate two pieces of mail equipment. Before the start of the remediation activities, all porous materials were removed from the mail area. Since all postremediation environmental samples were negative for growth of Bacillus anthracis spores, the remediation was judged to be effective. The facility remained closed for almost 4(1/2) months. The cleanup activities took about 2(1/2) months, with source reduction activities being the most time-consuming. Of the seven facilities that performed fumigations to remediate Bacillus anthracis contamination, the DOJ mail facility was the second building to be reopened.

Anthrax↗
PubMed2006

False alarms, real challenges--one university's communication response to the 2001 anthrax crisis.

Considerable research exists on how government agencies at the federal, state, and local levels communicated during the fall 2001 anthrax attacks. However, there is little research on how other institutions handled this crisis, in terms of their response to potential anthrax contamination (aka "white powder scares") and their approach to disseminating important health and safety information. In this article, we investigate a major university's communication response to the anthrax crisis. First, we describe its communication experiences relating to a large white powder scare that occurred in October 2001. Second, we describe the university's broader communication efforts in terms of several important elements of risk communication research, including influence of source attributes, key messages, preferred channels, responses to information requests, and organizational influences. This study underlines that an institution does not have to be directly affected by a crisis to find itself on the communication "front lines." Moreover, other institutions may find it useful to learn from the experiences of this university, so that they may communicate more effectively during future crises.

Anthrax↗
PubMed2003

Dietary advice in clinical practice: the views of general practitioners in Europe.

BACKGROUND: General practitioners (GPs) can promote good nutrition to patients and advise them about desirable dietary practices for specific conditions. OBJECTIVE: The objective was to assess GPs' knowledge and attitudes in implementing preventive and health promotion activities and to describe tools used by European GPs in advising patients about dietary practices. DESIGN: A postal survey was mailed to 1976 GPs from 10 GP national colleges to obtain information about beliefs and attitudes in prevention and health promotion, and an e-mail survey was sent to 15 GPs representing national colleges to obtain information about dietary guidelines. RESULTS: In the postal survey, 45% of GPs reported estimating body mass in clinical practice, and 60% reported advising overweight patients to lose weight. Fifty-eight percent answered that they felt minimally effective or ineffective in helping patients achieve or maintain normal weight. In the e-mail survey, only 4 colleges out of 15 reported that they had published their own dietary tools, although 10 out of 15 answered that GPs use some nutritional/dietary recommendations in the office when seeing patients. Eleven out of 15 answered that both the nurse and the GP advise patients about dietary practices, with 4 answering that GPs were the only ones who advise patients. Only 5 delegates answered that they can refer their patients to trained nutrition specialists. CONCLUSIONS: GPs think that obesity is not easy to handle in practice. Most GPs have dietary tools in the office and think that nurses play an important role in advising patients.

Adult↗
PubMed2002

Comparison of telephone and postal survey modes on respiratory symptoms and risk factors.

Little is known about the comparability of postal and telephone survey modes in epidemiology. A cross-sectional, population-based study (n = 25,000) of lung disease was performed in 1998-1999 in two regions of Norway. Initial surveying was done by postal questionnaire. A 1% random sample (n = 171) of previous postal responders were resurveyed by telephone or cellular contact. The response rate was 67% on the telephone/cellular interview. Fewer incomplete answers were given by telephone than by mail. A lower prevalence was found by telephone for morning cough and exposure to passive smoking at work or home. Reproducibility was high for asthma, hay fever, wheezing, and attacks of breathlessness. Moderate reproducibility was seen for symptoms of chronic bronchitis. Reproducibility was low for indoor and work environment, although it was high for early life factors. Concordance coefficients were high for all continuous measures such as height, body weight, and pack-years. The authors conclude that the comparability between the postal and the telephone survey modes was good. The telephone survey mode gave more complete information. Survey mode may have a moderate effect on study results, depending on the specific questions asked.

Adolescent↗
PubMed2002

Using a telephone survey to acquire genetic and behavioral data related to cigarette smoking in "made-anonymous" and "registry" samples.

In the Smokers and Nonsmokers Study, the authors investigated the feasibility of using random digit dialing telephone interviews to locate adults in the continental United States who were willing to provide DNA from buccal swabs through the mail. Interviews with 3,383 adults regarding their smoking-related behaviors (response rate = 70%) were conducted in 1999-2000; swab returns continued into early 2001. Overall, 57% of interviewees agreed to receive mailed information explaining the study. Better-educated persons (odds ratio (OR) = 1.3, 95% confidence interval (CI): 1.1, 1.6), younger persons (OR = 0.988, 95% CI: 0.983, 0.992), persons with symptoms of depression (OR = 1.8, 95% CI: 1.4, 2.4), and current smokers (OR = 2.25, 95% CI: 1.8, 2.8) were likelier to agree to receive a mailing. Approximately 26% of interviewees (45% of those receiving kits) returned buccal swabs, and 18% were successfully genotyped. Older (OR = 1.02, 95% CI: 1.01, 1.03), better-educated (OR = 1.4, 95% CI: 1.1, 1.7), and White (OR = 1.8, 95% CI: 1.4, 2.5) participants were more likely to return DNA samples, but current smokers (OR = 0.6, 95% CI: 0.5, 0.8) were less likely to do so. Participants were randomly assigned to one of two forms of participation: the "registry" group (names were kept on file) or the "made-anonymous" group (names were unassociated with samples). The two groups were equally likely to return kits, but registry respondents were more likely to nominate siblings for participation in the study (OR = 1.6, 95% CI: 1.2, 2.1). The participants in this study were similar demographically to the national population. The authors conclude that random digit dialing surveys coupled with mail collection of DNA may constitute a practical method of obtaining DNA samples for biobehavioral research.

Adult↗
PubMed2003

Randomized trial of financial incentives and delivery methods for improving response to a mailed questionnaire.

In a follow-up study, only 64% of 126,628 US radiologic technologists completed a questionnaire during 1994-1997 after two mailings. The authors conducted a randomized trial of financial incentives and delivery methods to identify the least costly approach for increasing overall participation. They randomly selected nine samples of 300 nonresponders each to receive combinations of no, 1.00 US dollar, 2.00 US dollars, and 5.00 US dollars cash or check incentives delivered by first-class mail or Federal Express. Federal Express delivery did not achieve greater participation than first-class mail (23.2% vs. 23.7%). In analyses pooled across delivery methods, the response was significantly greater for the 2.00 US dollar bill (28.9%, 95% confidence interval (CI): 25.2, 32.7; p < 0.0001), 5.00 US dollars check (27.5%, 95% CI: 22.5, 33.0; p = 0.0001), 1.00 US dollar bill (24.6%, 95% CI: 21.2, 28.3; p = 0.0007), and 2.00 US dollars check (21.8%, 95% CI: 18.5, 25.3; p = 0.02) compared with no incentive (16.6%, 95% CI: 13.7, 19.9). The response increased significantly with increasing incentive amounts from 0.00 to 2.00 US dollars cash (p trend < 0.0001). The 2.00 US dollar bill achieved a 30% greater response than did a 2.00 US dollars check (p = 0.005). For incentives sent by first-class mail, the 5.00 US dollars check yielded 30% greater participation than did the 2.00 US dollars check (p = 0.07). A 1.00 US dollar bill, chosen instead of the 2.00 US dollars bill because of substantially lower overall cost and sent by first-class mail to the remaining 42,717 nonresponders, increased response from 64% to 72%.

Adult↗
PubMed2005

Increasing response to mailed questionnaires by including a pencil/pen.

Nonmonetary incentives lead to small increases in response rates to mailed questionnaires. However, inclusion of a pen or pencil, which may be a facilitating factor as well as a reward, has not been shown to improve response to health surveys in prior trials. In 2001 and 2002, the authors conducted two US trials in which a study-logo pen or pencil was randomly included in a second questionnaire mailed to nonresponders to a first mailing. In the first study, of 10,686 nonresponders to a cohort recruitment mailing, response to the second mailing was 55% with inclusion of a pen versus 40% without one (p < 0.001). In the second study, of 141 nonresponders to a pilot follow-up survey conducted 2 years after entry into a cohort, response was 43% with inclusion of a pencil versus 24% without one (p = 0.02). This 15-19 percentage point increase for mailing 2 translated to a 5-6 percentage point increase after the two mailings combined. In a simulated study of three mailings based on these studies, the overall response rate increased by 4 percentage points at no added cost through inclusion of a pencil in the second mailing. The additional cost of the pencil was compensated for by the reduced number of nonrespondents sent packets at the third mailing. This study supports including a study-logo pen or pencil in a second questionnaire mailing to nonrespondents as a cost-effective method of increasing response rates.

Aged↗
PubMed1995

Failure of educational videotapes to improve medication compliance in a health maintenance organization.

The value of mailed educational videotapes as a means of enhancing compliance with drug therapy was studied. Members of a health maintenance organization with a pharmacy claim for benazepril, metoprolol, simvastatin, or transdermal estrogen were randomly assigned to a study group or a control group. Subjects in the study group were mailed one of four videotape programs giving information on the drug prescribed and the inferred disease state. Control subjects received no educational materials. Subjects were enrolled from July 1, 1993, through January 2, 1994. Refill data were collected from July 1, 1993, through April 1, 1994. The medication possession ratio (MPR) was calculated as the total number of days' supply of a drug obtained by a member divided by the number of days between the time of enrollment and April 1, 1994, or the date the member was terminated from the plan. A subject was deemed compliant if his or her MPR was > or = 0.80. There were no significant differences in mean MPRs between the study group (n = 1993) and the control group (n = 2253). None of the mean MPRs was > or = 0.80, although 44% of control subjects and 46% of study-group subjects were compliant. Of 97 respondents to a survey mailed to a randomly selected subset of the study group, almost 87% reported that they had viewed the videotapes, and of these subjects, about 88% said they found them very useful or somewhat useful. A one-time mailing of videotapes to patients, with no individual follow-up, did not increase compliance with the medications monitored.

Adult↗