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Using a diary to record near misses and minor injuries--which method of administration is best?
OBJECTIVES: To determine the effect of different methods of administering a diary to collect information from parents on near miss and minor injuries on responses, completeness and accuracy, the number of incidents reported, the effect of a financial incentive on response, and the cost of administering each method. SETTING: The study was set within the context of a cluster randomised controlled trial of injury prevention in 36 practices in Nottingham. METHODS: The study population comprised the 1594 parents who responded to the baseline questionnaire. Parents were allocated systematically to one of four groups: postal administration, with and without financial incentive, telephone administration, with and without financial incentive (102 in each group). A clinic visit method with and without financial incentive (50 in each group) was also used. RESULTS: A significant trend was found, with decreasing response rates with increasing degree of contact with the parent, such that administering the diary in the clinic had the lowest response (chi2 for trend = 5.54, 1 df, p = 0.02). Offering a financial incentive increased responses from 47% to 59% (chi2 = 5.78, 1 df, p = 0.016). The most complete recording was found in the diaries handed out at clinic visits. Importantly, parents were accurate in their recording of near miss and minor injuries, suggesting they understood the differences between the two types of incident. Postal methods were the least expensive method of administering the diary in terms of average cost per returned diary. Using a financial incentive resulted in a lower cost per returned diary for telephone and clinic visit methods. CONCLUSIONS: Parents can accurately and reliably complete diaries recording near miss and minor injuries occurring to their preschool children. More work is needed to investigate methods of increasing response. Postal diaries achieve the highest response but have the least complete recording of data. Diaries administered through child health clinics were most complete but achieved the lowest response. The administration method chosen in future work should be influenced both by the response and completeness of recording that is required by the research.
Validation of a home safety questionnaire used in a randomised controlled trial.
OBJECTIVE: To measure the validity of self reported safety practices from a questionnaire, completed by families participating in a home safety randomised controlled trial. METHODS: The postal questionnaire was used to measure secondary outcomes in a randomised controlled trial. The answers to 26 questions that could be assessed by observation were checked by a home visit. Families were invited to take part in a "home safety check"; they were not told that the visit was part of a validation study. At the time of the visit the researcher was blind to the self reports in the questionnaires. RESULTS: Sixty four questionnaires were validated by visits to 64 households. Percentage agreement ranged from 58% to 100%. Sensitivity was high (68% or above) for most safety practices. The positive predictive value was also high for most safety practices (78% or above for 15 of the 16 practices). CONCLUSIONS: This study found a fairly high degree of consistency between self reported data and actual observations. The findings from this relatively small study need confirmation from larger studies.
The use of electronic mail in biomedical communication.
OBJECTIVES: To determine whether there are statistically significant differences in the content of electronic mail (e-mail) and conventional mail sent to authors of papers published in medical journals. DESIGN: Prospective study by postal questionnaire. Over two one-month periods, corresponding authors of papers published in medical journals were asked to record details of the correspondence prompted by their publications. MEASUREMENTS: Conventional and e-mail correspondence received. Reprint requests. Content of correspondence. Quality of correspondence. RESULTS: Eighty-two of 96 authors replied. Fifty received e-mail (mean, 5.7+/-8.8 e-mails per author) and 72 received conventional mail (15.5+/-32.8 letters per author) (p < 0.05). Seventy percent of e-mails and only 53% of correspondence sent by conventional mail (p < 0.05) referred to the content of the paper. CONCLUSIONS: Publication in general medical journals stimulates more conventional than electronic mail. However, the content of e-mail may be of greater scientific relevance. Electronic mail can be encouraged without fear of diminishing the quality of the communications received.
Methods for the design and administration of web-based surveys.
This paper describes the design, development, and administration of a Web-based survey to determine the use of the Internet in clinical practice by 450 dental professionals. The survey blended principles of a controlled mail survey with data collection through a Web-based database application. The survey was implemented as a series of simple HTML pages and tested with a wide variety of operating environments. The response rate was 74.2 percent. Eighty-four percent of the participants completed the Web-based survey, and 16 percent used e-mail or fax. Problems identified during survey administration included incompatibilities/technical problems, usability problems, and a programming error. The cost of the Web-based survey was 38 percent less than that of an equivalent mail survey. A general formula for calculating breakeven points between electronic and hardcopy surveys is presented. Web-based surveys can significantly reduce turnaround time and cost compared with mail surveys and may enhance survey item completion rates.
The interrelationships and stability of Coulter S-determined blood indices.
The blood of 104 medical inpatients was examined at various intervals during storage for 72 hours using a Coulter S counter. Over this period remarkable stability of the white cell count, red cell count, haemoglobin, and mean cell haemoglobin was demonstrated. This permits a useful interpretation of indices obtained in routine postal samples sent to the laboratory by general practitioners for screening. Furthermore, the implications of high correlations between red cell indices in freshly examined blood are considered and the regression line MCV = 2.5 MCH + 16 is derived. Using this relationship the normal range of the Coulter S MCHC is defined as 32.6-33.7 g/dl. The significance of the Coulter MCHC in present-day practice is reassessed and the importance of recognizing values for MCV and MCH not coinciding with the regression line is briefly discussed.
The signing of laboratory reports.
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Can we evaluate population screening strategies in UK general practice? A pilot randomised controlled trial comparing postal and opportunistic screening for genital chlamydial infection.
STUDY OBJECTIVE: To assess whether opportunistic and postal screening strategies for Chlamydia trachomatis can be compared with usual care in a randomised trial in general practice. DESIGN: Feasibility study for a randomised controlled trial. SETTING: Three West of Scotland general medical practices: one rural, one urban/deprived, and one urban/affluent. PARTICIPANTS: 600 women aged 16-30 years, 200 from each of three participating practices selected at random from a sample of West of Scotland practices that had expressed interest in the study. The women could opt out of the study. Those who did not were randomly assigned to one of three groups: postal screening, opportunistic screening, or usual care. RESULTS: 38% (85 of 221) of the approached practices expressed interest in the study. Data were collected successfully from the three participating practices. There were considerable workload implications for staff. Altogether 124 of the 600 women opted out of the study. During the four month study period, 55% (81 of 146) of the control group attended their practice but none was offered screening. Some 59% (80 of 136) women in the opportunistic group attended their practice of whom 55% (44 of 80) were offered screening. Of those, 64% (28 of 44) accepted, representing 21% of the opportunistic group. Forty eight per cent (59 of 124) of the postal group returned samples. CONCLUSION: A randomised controlled trial comparing postal and opportunistic screening for chlamydial infection in general practice is feasible, although resource intensive. There may be problems with generalizing from screening trials in which patients may opt out from the offer of screening.
A monetary incentive increases postal survey response rates for pharmacists.
BACKGROUND: Achieving acceptable response rates from health care providers via postal questionnaires is an ongoing challenge. The use of monetary incentives is one of the most effective strategies for increasing response rates. However, the effect and cost of such an incentive on retail pharmacists' response rates has not been well studied. METHODS: A sample of 700 pharmacies was selected at random from the electronic Yellow Pages in NSW Australia and mailed a brief survey regarding pharmacotherapies and advice for smoking cessation. Half of the sample was randomly allocated to receive an offer of an 14 US dollars gift voucher. RESULTS: The response rates were 65.9% for the voucher group and 53.5% for the no-voucher group. The odds of response from the voucher group was 1.68 (95%CI = 1.23, 2.30) times greater than for the no-voucher group. The cost per additional respondent was 67.95 US dollars. The incentive also reduced follow up costs by 10%. CONCLUSIONS: A moderately sized monetary incentive is able to achieve a significant increase in response rates for retail pharmacists, thereby reducing potential bias in the sample.
Evaluation of postal detection of registrable blindness.
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Hospital discharges in relation to area of residence.
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Factors affecting response to postal questionnaires.
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Response to typed and mimeographed letters in a survey using postal questionnaires.
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Acceptability of the cytopipette in screening for cervical cancer.
A randomized controlled trial was carried out in which the acceptability of screening for cervical carcinoma in situ by a postal 'do-it-yourself' method--the cytopipette--was compared with that of an invitation to attend a clinic or see a general practitioner for the conventional cervical scrape examination. In parallel with this, a sociological study of women who had been invited by both methods was undertaken in which information was obtained from responders and non-responders on attitudes to health care. The results show that, while the pipette was used by a greater proportion of women overall than the scrape examination, its acceptance by women most at risk of the disease is still not high. It is concluded that, taking into account the relative merits of the two methods as screening tests, as well as their acceptability and cost, the postal pipette may be useful in some circumstances, such as areas where clinical resources are limited, and as a second approach to women who have not taken up the offer of a scrape examination.
Estimating the prevalence of disability in the community: the influence of sample design and response bias.
An estimate of the prevalence of physical disability in the community based upon a sample survey may be influenced by the sample design and the response to the method of data collection employed. In this paper we describe a postal survey of a sample of households in the London borough of Lambeth and the procedures used for calculating the influence of these factors on the estimate produced. These procedures can be used to adjust the estimate to take account of the relative chance of households falling into the sample and to correct for non-response bias.
Who responds to postal questionnaires?
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Does anonymity increase response rate in postal questionnaire surveys about sensitive subjects? A randomised trial.
STUDY OBJECTIVE: The aim of the study was to determine whether complete anonymity improves the response rates to a postal questionnaire. DESIGN: The study derived from a series of postal surveys on AIDS knowledge conducted on six different dates in 1986 and 1987. The sample was randomly divided into two, each group being sent the same questionnaire. One group was informed that the replies were anonymous, the other that they were not. The latter were sent reminders. SETTING: Recipients of the questionnaires were drawn from the Southampton electoral rolls. PARTICIPANTS: 300 people in each survey (total 1800) were sent questionnaires, representing on each occasion a different 1:500 systematic sample. RESULTS: Response rate was 49% for the anonymous questionnaires and 51% for the numbered questionnaires. Reminders boosted the response in the numbered group to 72%. CONCLUSIONS: There is no evidence that anonymity improves response to postal questionnaires, but the use of reminders may do so.
Postal survey on airborne occupational exposure and respiratory disorders in Norway: causes and consequences of non-response.
STUDY OBJECTIVE: The aim was to examine causes for non-response in a community survey, and how non-response influences prevalence estimates of some exposure and disease variables, and associations between the variables. DESIGN: This was a cross sectional questionnaire study with two reminder letters. The questionnaire asked for information on smoking habits, occupational airborne exposure and respiratory disorders. SETTING: A random sample of 4992 subjects from the general population aged 15-70 years of Hordaland County, Norway. MAIN RESULTS: The overall response rate was 90%, with a 63% response to the initial letter. The response rates to the first and second reminder letters were 56% and 36% respectively. In 20% of the non-respondents an uncompleted questionnaire was returned with cause for non-response; in two thirds of these the cause for non-response was that the subject was not resident at the mailing address. A home visit to a random sample of 50 urban non-respondents provided further information on 29 subjects. A wrong address at the Central Population Registry and the subject's feeling of lack of personal benefit from a postal survey were the major reasons for non-response. Smokers were late respondents and subjects with respiratory disorders tended to be early respondents. CONCLUSION: The main reasons for non-response were a wrong mailing address and a feeling of lack of personal benefit from responding. Using only the initial letter would have changed the estimated prevalence of smokers from 39% to 35%. Otherwise, the estimated prevalence of the exposure and disease variables as well as the associations between them were only slightly changed after including the respondents to the first and second reminder letters.