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PubMed2006

Survey response inducements for registered nurses.

The past 20 years have seen an overall decline in survey response rates and an even more pronounced decline in samples of health care professionals. The authors tested the use of a "thank you" or "reminder" postcard as a method by which to stem the tide of declining response rates. The authors conducted a mail and telephone survey of 49,605 registered nurses for the 2000 National Sample Survey of Registered Nurses and sent an extra mailing to a random subsample (n = 4,968). They then compared response rates for both groups. Contrary to prior research, this study found that reminder postcards did not improve response rates or rates of return. There may be several reasons for this finding, including the general familiarity with, and high saliency of, this research project for the nursing community. These results suggest that even widely accepted best practices for survey methods deserve scrutiny when applied to special subpopulations.

Adult↗
PubMed1997

Comparison of postal version of the Frenchay Activities Index with interviewer-administered version for use in people with stroke.

OBJECTIVE: To assess the agreement between postal and interviewer-administered versions of the Frenchay Activities Index (FAI) and to assess the criterion validity of the postal version, using interviewer administration as a gold standard. DESIGN: Comparison of responses to FAI administered by post and then by interview (median delay 10 days). SUBJECTS: Forty-eight Oxfordshire residents admitted to hospital with acute stroke between 1 August 1994 and 31 January 1995 and discharged alive within six months of their stroke. RESULTS: The limits of agreement of the total FAI score are from -5.4 to 7.2. The kappa statistic for each of the 15 individual items that make up the FAI ranged from 0.35 to 1. For nine items, agreement was moderate or fair, and for six items, agreement was good or very good. The mean difference between the overall scores was 0.9 (95% confidence interval: -0.1 to 1.9). The correlation between the overall scores was 0.94 (Spearman's rank correlation coefficient). CONCLUSION: The postal version of the FAI is a satisfactory alternative to direct administration, but poor agreement in scores for individual patients emphasizes that the two approaches should not be used sequentially to monitor individual patients.

Activities of Daily Living↗
PubMed2003

Quitting ecstasy: an investigation of why people stop taking the drug and their subsequent mental health.

The regular use of ecstasy (3,4-methylenedioxymethamphetamine, MDMA) has been associated with depressed mood, anxiety and hostility, but it is not known whether such effects persist after people stop using the drug. Furthermore, little is known about what factors might influence the decision to quit using MDMA. The aim of the present study was to examine the reasons why ex-users had stopped using this drug and to assess their current levels of depression, anxiety, anger and aggression. Telephone interviews were conducted with people who used to take MDMA on a regular basis but who no longer used the drug. The participants comprised sixty-six ex-users who used to take MDMA regularly (at least once every 2 months over a period of at least 1 year), but who had not taken MDMA for at least 1 year (average 3 years). Participants were asked about why they had quit MDMA. They also completed questionnaires to assess trait mood. Ex-users could be divided into two groups based on their reason for quitting: (i) those who had quit for mental health reasons and (ii) those who had quit for circumstantial reasons. Approximately half of those in the mental health group scored in the range for clinical depression. In that group, current levels of depression and anxiety correlated significantly with the cumulative amount of MDMA that they had taken several years previously. These findings suggest that some users may either be more vulnerable to the adverse effects of MDMA or have pre-existing mental health problems for which they self-medicate by using ecstasy. The present study shows that some ex-users experience an impairment to mental health that persists for years after they stop using this drug.

Adult↗
PubMed1993

A comparison of mail and telephone interview strategies for mental health surveys.

The high cost of mental health surveys of the general population has sparked interest in less costly research methods. Two low-cost mental health survey strategies (mail and telephone) were compared in terms of cost, response rate and quality of data obtained. A total of 1,074 persons agreed to participate in the study as a sample, one-half by telephone and the other half by mail. They completed the Diagnostic Interview Schedule Self-Administered, a questionnaire designed to be self-administered, which was used to assess specific mental disorders and to evaluate risk factors. In addition, 239 respondents who were selected according to the presence or absence of specific diagnoses were reinterviewed face-to-face using the Diagnostic Interview Schedule as an external criterion. The telephone method yielded a better response rate (15% higher) and better control over answers (for example, less missing data). The mail strategy was less expensive and appeared to yield data of slightly better quality, particularly for respondents suffering from anxiety disorders.

Adolescent↗
PubMed2005

'Stop pub': can banning of junk mail reduce waste production?

According to the new regulations on junk mail management to be adopted in France, both producers and distributors must participate in the recycling process. This case study was carried out in 2000 in four sectors in the Departement of Charente in the south west of France. This report presents the quantities of junk mail in residual waste and in separate collections. The conclusion is that the new regulations may reduce overall domestic waste production by 2-4%, with the impact on separately collected paper being some 20%.

Conservation of Natural Resources↗
PubMed2005

Identifying churches for community-based mammography promotion: lessons from the LAMP study.

There is great potential in public health and faith communities partnering to promote health education and research. This article describes lessons learned from the design and implementation of such a partnership, the Los Angeles Mammography Promotion in Churches Program (LAMP). It is feasible, although challenging, to enumerate and survey churches in a geographically defined urban population, using data compiled from telephone directories, religious sources (e.g., denominational networks), chambers of commerce, and newspapers. Among those sources, telephone directories provided the broadest coverage, whereas religious sources yielded the highest recruitment rate. For collecting survey data from churches, telephone methods are superior to mail methods. For church-based health education programs that seek comprehensive coverage and have adequate resources, it is recommended that telephone directories be combined with religious sources to identify target churches. For programs with limited resources and less emphasis on comprehensive coverage, using religious sources alone is recommended.

Aged↗
PubMed1998

Follow-up of sporadic cases of food-borne infection: comparison of a postal questionnaire with a personal visit.

The aim of the study was to evaluate the follow-up of sporadic cases of suspected food-borne illness by either a postal questionnaire or a personal visit by environmental health staff. This was achieved by comparing the practice in two authority areas within the West Pennine Health Authority in the north west of England. We included all identified cases of suspected food poisoning, campylobacteriosis, cryptosporidiosis, salmonellosis and dysentery occurring in the district between 1 July and 30 September 1996. The main outcome measures were: (1) the proportion of all cases which were successfully followed-up by each method; (2) the timeliness of follow-ups; (3) qualitative estimation by environmental health staff of the data obtained. Visiting by environmental health staff was successful in obtaining information from 76.3% (106/139) of cases, while the postal questionnaires elicited a 52% (50/96) response rate. We found that 70.5% of visits occurred within one week of notification. Although 69.8% (67/96) of questionnaires were issued within one week of notification, only 16% of replies to the questionnaire were received within this period. The information provided on the returned questionnaires was found by environmental health staff to be generally as useful as that obtained by visiting.

Adolescent↗
PubMed2005

When bioterrorism strikes: communication issues for the local health department.

Public health preparedness is a multifaceted planning process that becomes grounded in a response plan and in effective communications, internal and external. This article describes an incident when the presence of anthrax spores was detected in a postal facility within Kansas City, Missouri, and discusses the communications issues faced by the Kansas City Health Department (KCHD). This incident provided the KCHD the first opportunity to operationalize its Incident Management System-based response plan. However, accompanying its implementation were unforeseen issues related to both internal and external communications. These issues and the lessons learned are discussed.

Anthrax↗
PubMed1998

Effectiveness of postal smoking cessation advice: a randomized controlled trial in young men with reduced FEV1 and asbestos exposure.

There have been few community-based randomized, controlled intervention trials for cessation in high-risk smokers. In such a trial we evaluated the effects of postal smoking cessation advice in smokers with asbestos exposure and/or reduced forced expiratory volume in one second (FEV1). All men aged 30-45 yrs (n=22,392) living in 34 municipalities in western Norway were invited to a cross-sectional community survey. Information on smoking habits and occupational asbestos exposure were obtained from self-administered questionnaires and measurements of FEV1 were performed with dry-wedge bellow spirometers. Among 16,393 participants we identified a group of 2,610 smokers with previous occupational asbestos exposure and/or adjusted FEV1 in the lowest quartile. A random half (n=1,300) received a mailed personal letter from a respiratory physician with a person-specific health advice to quit smoking and a pamphlet on smoking cessation. The remaining smokers (n=1,310) acted as controls and did not receive any information. Twelve months after the intervention, information on smoking habits was re-examined using a postal questionnaire. Among the respondents (n=2,282), smoking cessation was reported altogether by 13.7% in the intervention group versus 9.9% in the control group (p<0.01). The 1 yr sustained quit rate (no smoking at all during the last year) was 5.6 versus 35% (p<0.05), respectively. Measurements of carbon monoxide in expired air (with < or = 10 parts per million) confirmed self-reported nonsmoking in samples of the two groups. In a community this simple postal smoking cessation advice from a respiratory physician based on person-specific risk factors improved the 1 yr sustained success rate by 60% in identified high-risk smokers.

Adult↗
PubMed2004

Surveying general practitioners: a new avenue.

BACKGROUND: The validity of opinions expressed in questionnaire surveys diminishes with lower response rates. Recent research suggests that general practitioners (GPs) are more likely to respond to questionnaire surveys if they are motivated to do so because the subject of the survey is perceived as relevant to the practitioner at the time of the survey, and there is an opportunity to respond without encroaching on existing obligations or interests. AIM: To compare the results of a questionnaire survey administered by two routes: a postal survey with reminders and after an educational meeting with no reminders. METHODS: A validated questionnaire with 19 questions using a Likert scale seeking views about the ideal contents of a referral letter to colorectal surgeons was administered to GPs attending a monthly educational meeting in one locality in the UK and by post to a different group in a second locality. The response rate and demographic characteristics of the GPs were compared for respondents, non-respondents, attenders and non-attenders to the educational meeting. The mean responses to the questions on the Likert scale were used to produce a schedule to score the contents of referral letters. The schedules produced by the two methods (postal/educational meeting) were used to score 551 referral letters at one district general hospital. Mean scores calculated using the two schedules derived by the postal and educational routes were compared. Cases diagnosed with 'significant organic pathology' as defined in a previous study were identified. The predictive value of the scores in identifying these cases was compared. RESULTS: 88% (138/157) of GPs in the locality attended the educational meeting and were invited to participate in the survey. Non-attenders were more likely to be assistants, locums or part-time practitioners. Overall 71% (98) of the GPs responded to the survey. There were no significant demographic differences between the respondents and non-respondents to the survey. Response rates to the survey conducted by the two routes were similar. Referral letter 'quality' scores derived via the two alternative routes were equally valuable in predicting which patients had significant organic pathology. CONCLUSIONS: Responses to questionnaire surveys are equally valid when administered via an educational meeting or by post. The value of the educational meeting approach was the relative ease of administering the questionnaire and the rapid turn around of replies. However this method may exclude the views of part-time practitioners who were more likely to fail to attend. These practitioners may need to be targeted by alternative routes in questionnaire surveys.

Attitude of Health Personnel↗
PubMed2001

Effect of paper quality on the response rate to a postal survey: a randomised controlled trial. ISRCTN 32032031.

BACKGROUND: Response rates to surveys are declining and this threatens the validity and generalisability of their findings. We wanted to determine whether paper quality influences the response rate to postal surveys METHODS: A postal questionnaire was sent to all members of the British Society of Gynaecological Endoscopy (BSGE). Recipients were randomised to receiving the questionnaire printed on standard quality paper or high quality paper. RESULTS: The response rate for the recipients of high quality paper was 43/195 (22%) and 57/194 (29%) for standard quality paper (relative rate of response 0.75, 95% CI 0.33-1.05, p = 0.1 CONCLUSION: The use of high quality paper did not increase response rates to a questionnaire survey of gynaecologists affiliated to an endoscopic society.

Data Collection↗
PubMed2005

Early life factors, childhood cognition and postal questionnaire response rate in middle age: the Aberdeen Children of the 1950s study.

BACKGROUND: Little is known about the relationship between early life factors and survey response in epidemiological studies of adults. METHODS: The Children of the 1950s cohort is composed of 12,150 children (boys 51.7%) born in Aberdeen 1950-56 and in primary schools in the city in 1962. Information on birth weight, gestational age, growth, behaviour and socio-economic position at birth and in childhood were obtained from contemporaneous records. Cognitive test scores at ages 7,9 and 11 years were also available from school records. The outcome was response to a postal questionnaire sent (2001-2003) to surviving cohort members in middle age. RESULTS: Of 11,282 potentially mailed subjects, 7,183 (63.7%) returned questionnaires. Response rates were highest among females, and those whose parents were married at birth, were in a non-manual social class at birth or in childhood, had fewer siblings, were taller and heavier in childhood for their age and had lower Rutter B behavioural scores. Childhood cognitive test scores at every age were strongly and positively related to the response rate to a postal questionnaire independently of other early life factors monotonically across the entire range of test scores. Those in the bottom fifth at age 11 had a response rate of 49% while those in the top fifth 75%. CONCLUSION: The strength and consistency of the association of childhood cognition with questionnaire response rate in middle age is surprisingly large. It suggests that childhood cognition across the entire normal range is a powerful influence on the complex set of later behaviours that comprise questionnaire response. The extent of possible response bias in epidemiological studies of the associations between childhood characteristics (particularly those related to cognition) and later health is probably larger than is generally realised, at least in situations where the survey instrument is a postal questionnaire.

Child↗
PubMed2005

A randomised controlled trial to assess the effectiveness of offering study results as an incentive to increase response rates to postal questionnaires [ISRCTN26118436].

BACKGROUND: Postal questionnaires are widely used to collect outcome data on participants. However, a poor response to questionnaires will reduce the statistical power of the study and may introduce bias. A meta analysis of ten trials offering study results, largely in the fields of education and marketing, was shown to be ineffective, with the odds ratio for response with offering research findings is 0.92 (95% CI 0.75 to 1.11). However uncertainty still exists as it is uncertain whether results from such trials can be extrapolated to that of a health care setting. The aim of this study was to assess whether offering participants study results increases the response rates to postal questionnaires. METHODS: 1038 women aged over 70 years were remotely randomised by computer in a 3:1 ratio. 250 participants did not receive the offer of knowing the results of the trial and 788 participants were offered the results of the trial in a postal questionnaire. The main outcome measure was response rate. Chi square test was used to evaluate the overall differences in response rate between the two groups. An adjusted analysis, adjusting for whether the participant was taking calcium and age was also undertaken. RESULTS: The response rates were not significantly different Odds Ratio 0.88 (95% confidence intervals 0.48 to 1.63) p = 0.69. CONCLUSION: Offering study results to women living in the community aged over 70 does not increase response rates to postal questionnaires. Although researchers have an ethical obligation to offer participants study results, since 10% of women did not wish to receive the results, investigators should give participants the option to opt out of receiving the study's results.

Aged↗
PubMed2005

A randomized trial of mail vs. telephone invitation to a community-based cardiovascular health awareness program for older family practice patients [ISRCTN61739603].

BACKGROUND: Family physicians can play an important role in encouraging patients to participate in community-based health promotion initiatives designed to supplement and enhance their in-office care. Our objectives were to determine effective approaches to invite older family practice patients to attend cardiovascular health awareness sessions in community pharmacies, and to assess the feasibility and acceptability of a program incorporating invitation by physicians and feedback to physicians. METHODS: We conducted a prospective randomized trial with 1 family physician practice and 5 community pharmacies in Dundas, Ontario. Regular patients 65 years or older (n = 235) were randomly allocated to invitation by mail or telephone to attend pharmacy cardiovascular health awareness sessions led by volunteer peer health educators. A health record review captured blood pressure status, monitoring and control. At the sessions, volunteers helped patients to measure blood pressure using in-store machines and a validated portable device (BPM-100), and recorded blood pressure readings and self-reported cardiovascular risk factors. We compared attendance rates in the mail and telephone invitation groups and explored factors potentially associated with attendance. RESULTS: The 119 patients invited by mail and 116 patients contacted by telephone had a mean age of 75.7 (SD, 6.4) years and 46.8% were male. Overall, 58.3% (137/235) of invitees attended a pharmacy cardiovascular health awareness session. Patients invited by telephone were more likely to attend than those invited by mail (72.3% vs. 44.0%, OR 3.3; 95%CI 1.9-5.7; p < 0.001). CONCLUSION: While the attendance in response to a telephone invitation was higher, response to a single letter was substantial. Attendance rates indicated considerable interest in community-based cardiovascular health promotion activities. A large-scale trial of a pharmacy cardiovascular health awareness program for older primary care patients is feasible.

Aged↗
PubMed2007

Barriers to apply cardiovascular prediction rules in primary care: a postal survey.

BACKGROUND: Although cardiovascular prediction rules are recommended by guidelines to evaluate global cardiovascular risk for primary prevention, they are rarely used in primary care. Little is known about barriers for application. The objective of this study was to evaluate barriers impeding the application of cardiovascular prediction rules in primary prevention. METHODS: We performed a postal survey among general physicians in two Swiss Cantons by a purpose designed questionnaire. RESULTS: 356 of 772 dispatched questionnaires were returned (response rate 49.3%). About three quarters (74%) of general physicians rarely or never use cardiovascular prediction rules. Most often stated barriers to apply prediction rules among rarely- or never-users are doubts concerning over-simplification of risk assessment using these instruments (58%) and potential risk of (medical) over-treatment (54%). 57% report that the numerical information resulting from prediction rules is often not helpful for decision-making in practice. CONCLUSION: If regular application of cardiovascular prediction rules in primary care is in demand additional interventions are needed to increase acceptance of these tools for patient management among general physicians.

Attitude of Health Personnel↗
PubMed2006

Does population screening for Chlamydia trachomatis raise anxiety among those tested? Findings from a population based chlamydia screening study.

BACKGROUND: The advent of urine testing for Chlamydia trachomatis has raised the possibility of large-scale screening for this sexually transmitted infection, which is now the most common in the United Kingdom. The purpose of this study was to investigate the effect of an invitation to be screened for chlamydia and of receiving a negative result on levels of anxiety, depression and self-esteem. METHODS: 19,773 men and women aged 16 to 39 years, selected at random from 27 general practices in two large city areas (Bristol and Birmingham) were invited by post to send home-collected urine samples or vulvo-vaginal swabs for chlamydia testing. Questionnaires enquiring about anxiety, depression and self-esteem were sent to random samples of those offered screening: one month before the dispatch of invitations; when participants returned samples; and after receiving a negative result. RESULTS: Home screening was associated with an overall reduction in anxiety scores. An invitation to participate did not increase anxiety levels. Anxiety scores in men were lower after receiving the invitation than at baseline. Amongst women anxiety was reduced after receipt of negative test results. Neither depression nor self-esteem scores were affected by screening. CONCLUSION: Postal screening for chlamydia does not appear to have a negative impact on overall psychological well-being and can lead to a decrease in anxiety levels among respondents. There is, however, a clear difference between men and women in when this reduction occurs.

Adolescent↗