The effectiveness of a monetary incentive offer on survey response rates and response completeness in a longitudinal study

Internet use and physical and mental health in old age during the COVID-19 pandemic: Evidence from partners in SHARE

Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we investigate whether individuals aged 65 and older who were internet users prior to the COVID-19 pandemic experienced better physical and mental health, during the pandemic, than age peers who did not use the internet. We consider three health outcomes: self-reported health, overweight/obesity and depression. To account for household-shared determinants of health and reverse causality, we estimate household fixed effects regressions on samples of individuals grouped into households of cohabiting partners who exhibited identical pre-pandemic health outcomes. On average, our estimates point towards a non-significant effect of internet use on all health outcomes. The probability of depression varied by age: pre-pandemic internet users in the age-range 65-70 were more likely to experience depression, whereas those aged over 80 were less likely to be depressed, compared to internet nonusers in the same age-range. Moreover, we find that, among older pre-pandemic internet nonusers, those with stronger social ties had better access to remote medical consultations during the pandemic; this result suggests that social capital may play a protective role and may contribute to bridging the digital divide. We conclude that, although internet use holds significant potential benefits for older adults, its impact, particularly on mental health, is complex and multifaceted. Future interventions should be tailored to address these nuances, promoting beneficial uses of digital technology while mitigating its adverse effects.

Using routinely available electronic health record data elements to develop and validate a digital divide risk score

Background

Digital health (patient portals, remote monitoring devices, video visits) is a routine part of health care, though the digital divide may affect access.

Objectives

To test and validate an electronic health record (EHR) screening tool to identify patients at risk of the digital divide.

Materials and Methods

We conducted a retrospective EHR data extraction and cross-sectional survey of participants within 1 health care system. We identified 4 potential digital divide markers from the EHR: (1) mobile phone number, (2) email address, (3) active patient portal, and (4) >2 patient portal logins in the last year. We mailed surveys to patients at higher risk (missing all 4 markers), intermediate risk (missing 1-3 markers), or lower risk (missing no markers). Combining EHR and survey data, we summarized the markers into risk scores and evaluated its association with patients' report of lack of Internet access. Then, we assessed the association of EHR markers and eHealth Literacy Scale survey outcomes.

Results

A total of 249 patients (39.4%) completed the survey (53%>65 years, 51% female, 50% minority race, 55% rural/small town residents, 46% private insurance, 45% Medicare). Individually, the 4 EHR markers had high sensitivity (range 81%-95%) and specificity (range 65%-79%) compared with survey responses. The EHR marker-based score (high risk, intermediate risk, low risk) predicted absence of Internet access (receiver operator characteristics c-statistic=0.77). Mean digital health literacy scores significantly decreased as her marker digital divide risk increased (P  <.001).

Discussion

Each of the four EHR markers (Cell phone, email address, patient portal active, and patient portal actively used) compared with self-report yielded high levels of sensitivity, specificity, and overall accuracy.

Conclusion

Using these markers, health care systems could target interventions and implementation strategies to support equitable patient access to digital health.

Strategies to Increase Response Rate and Reduce Nonresponse Bias in Population Health Research: Analysis of a Series of Randomized Controlled Experiments during a Large COVID-19 Study

Background

High response rates are needed in population-based studies, as nonresponse reduces effective sample size and bias affects accuracy and decreases the generalizability of the study findings.

Objective

We tested different strategies to improve response rate and reduce nonresponse bias in a national population-based COVID-19 surveillance program in England, United Kingdom.

Methods

Over 19 rounds, a random sample of individuals aged 5 years and older from the general population in England were invited by mail to complete a web-based questionnaire and return a swab for SARS-CoV-2 testing. We carried out several nested randomized controlled experiments to measure the impact on response rates of different interventions, including (1) variations in invitation and reminder letters and SMS text messages and (2) the offer of a conditional monetary incentive to return a swab, reporting absolute changes in response and relative response rate (95% CIs).

Results

Monetary incentives increased the response rate (completed swabs returned as a proportion of the number of individuals invited) across all age groups, sex at birth, and area deprivation with the biggest increase among the lowest responders, namely teenagers and young adults and those living in more deprived areas. With no monetary incentive, the response rate was 3.4% in participants aged 18-22 years, increasing to 8.1% with a £10 (US $12.5) incentive, 11.9% with £20 (US $25.0), and 18.2% with £30 (US $37.5) (relative response rate 2.4 [95% CI 2.0-2.9], 3.5 [95% CI 3.0-4.2], and 5.4 [95% CI 4.4-6.7], respectively). Nonmonetary strategies had a modest, if any, impact on response rate. The largest effect was observed for sending an additional swab reminder (SMS text message or email). For example, those receiving an additional SMS text message were more likely to return a completed swab compared to those receiving the standard email-SMS approach, 73.3% versus 70.2%: percentage difference 3.1% (95% CI 2.2%-4.0%).

Conclusions

Conditional monetary incentives improved response rates to a web-based survey, which required the return of a swab test, particularly for younger age groups. Used in a selective way, incentives may be an effective strategy for improving sample response and representativeness in population-based studies.

Assessing the Response Results of an mHealth-Based Patient Experience Survey Among People Receiving HIV Care in Lusaka, Zambia: Cohort Study

BACKGROUND

This pilot study evaluates the effectiveness of mobile talk-time incentives in maintaining participation in a longitudinal mobile health (mHealth) data collection program among people living with HIV in Lusaka, Zambia. While mHealth tools, such as mobile phone surveys, provide vital health feedback, optimal incentive strategies to ensure long-term engagement remain limited. This study explores how different incentive levels affect response rates in multiple survey rounds, providing insights into effective methods for encouraging ongoing participation, especially in the context of Zambia's prepaid mobile system and multi-SIM usage, a common practice in sub-Saharan Africa.

OBJECTIVE

This study aimed to assess the response rate success across multiple invitations to participate in a care experience survey using a mobile phone short codes and unstructured supplementary service data (USSD) model among individuals in an HIV care setting in the Lusaka, Zambia.

METHODS

Participants were recruited from 2 study clinics-1 in a periurban setting and 1 in an urban setting. A total of 2 rounds of survey invitations were sent to study participants on a 3-month interval between November 1, 2018, and September 23, 2019. Overall, 3 incentive levels were randomly assigned by participant and survey round: (1) no incentive, (2) 2 Zambian Kwacha (ZMW; US $0.16), and (3) 5 ZMW (US $0.42). Survey response rates were analyzed using mixed-effects Poisson regression, adjusting for individual- and facility-level factors. Probability plots for survey completion were generated based on language, incentive level, and survey round. We projected the cost per additional response for different incentive levels.

RESULTS

A total of 1006 participants were enrolled, with 72.3% (727/1006) from the urban HIV care facility and 62.4% (628/1006) requesting the survey in English. We sent a total of 1992 survey invitations for both rounds. Overall, survey completion across both surveys was 32.1% (637/1992), with significantly different survey completion between the first (40.5%, 95% CI 37.4-43.6%) and second (23.7%, 95% CI 21.1-26.4) invitations. Implementing a 5 ZMW (US $0.42) incentive significantly increased the adjusted prevalence ratio (aPR) for survey completion compared with those that received no incentive (aPR 1.35, 95% CI 1.11-1.63). The cost per additional response was highest at 5 ZMW, equivalent to US $0.42 (72.8 ZMW [US $5.82] per 1% increase in response).

CONCLUSIONS

We observed a sharp decline of almost 50% in survey completion success from the initial invitation to follow-up survey administered 3 months later. This substantial decrease suggests that longitudinal data collection potential for a care experience survey may be limited without additional sensitization and, potentially, added survey reminders. Implementing a moderate incentive increased response rates to our health care experience survey. Tailoring survey strategies to accommodate language preferences and providing moderate incentives can optimize response rates in Zambia.

TRIAL REGISTRATION

Pan African Clinical Trial Registry PACTR202101847907585; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=14613.

The Impact of Incentives on Data Collection for Online Surveys: Social Media Recruitment Study

BACKGROUND

The use of targeted advertisements on social media platforms (eg, Facebook and Instagram) has become increasingly popular for recruiting participants for online survey research. Many of these surveys offer monetary incentives for survey completion in the form of gift cards; however, little is known about whether the incentive amount impacts the cost, speed, and quality of data collection.

OBJECTIVE

This experiment addresses this gap in the literature by examining how different incentives in paid advertising campaigns on Instagram for completing a 10-minute online survey influence the response rate, recruitment advertising cost, data quality, and length of data collection.

METHODS

This experiment tested three incentive conditions using three Instagram campaigns that were each allocated a US $1400 budget to spend over a maximum of 4 days; ads targeted users aged 15-24 years in three nonadjacent designated market areas of similar size to avoid overlapping audiences. Four ad creatives were designed for each campaign; all ads featured the same images and text, but the incentive amount varied: no incentive, US $5 gift card, and US $15 gift card. All ads had a clickable link that directed users to an eligibility screener and a 10-minute online survey, if eligible. Each campaign ran for either the full allotted time (4 days) or until there were 150 total survey completes, prior to data quality checks for fraud.

RESULTS

The US $15 incentive condition resulted in the quickest and cheapest data collection, requiring 17 hours and ad spending of US $338.64 to achieve 142 survey completes. The US $5 condition took more than twice as long (39 hours) and cost US $864.33 in ad spending to achieve 148 survey completes. The no-incentive condition ran for 60 hours, spending nearly the full budget (US $1398.23), and achieved only 24 survey completes. The US $15 and US $5 incentive conditions had similar levels of fraudulent respondents, whereas the no-incentive condition had no fraudulent respondents. The completion rate for the US $15 and US $5 incentive conditions were 93.4% (155/166) and 89.8% (149/166), respectively, while the completion rate for the no-incentive condition was 43.6% (24/55).

CONCLUSIONS

Overall, we found that a higher incentive resulted in quicker data collection, less money spent on ads, and higher response rates, despite some fraudulent cases that had to be dropped from the sample. However, when considering the total incentive amounts in addition to the ad spending, a US $5 incentive appeared to be the most cost-effective data collection option. Other costs associated with running a campaign for a longer period should also be considered. A longer experiment is warranted to determine whether fraud varies over time across conditions.

Feasibility Study on Menstrual Cycles With Fitbit Device (FEMFIT): Prospective Observational Cohort Study

BACKGROUND

Despite its importance to women's reproductive health and its impact on women's daily lives, the menstrual cycle, its regulation, and its impact on health remain poorly understood. As conventional clinical trials rely on infrequent in-person assessments, digital studies with wearable devices enable the collection of longitudinal subjective and objective measures.

OBJECTIVE

The study aims to explore the technical feasibility of collecting combined wearable and digital questionnaire data and its potential for gaining biological insights into the menstrual cycle.

METHODS

This prospective observational cohort study was conducted online over 12 weeks. A total of 42 cisgender women were recruited by their local gynecologist in Berlin, Germany, and given a Fitbit Inspire 2 device and access to a study app with digital questionnaires. Statistical analysis included descriptive statistics on user behavior and retention, as well as a comparative analysis of symptoms from the digital questionnaires with metrics from the sensor devices at different phases of the menstrual cycle.

RESULTS

The average time spent in the study was 63.3 (SD 33.0) days with 9 of the 42 individuals dropping out within 2 weeks of the start of the study. We collected partial data from 114 ovulatory cycles, encompassing 33 participants, and obtained complete data from a total of 50 cycles. Participants reported a total of 2468 symptoms in the daily questionnaires administered during the luteal phase and menses. Despite difficulties with data completeness, the combined questionnaire and sensor data collection was technically feasible and provided interesting biological insights. We observed an increased heart rate in the mid and end luteal phase compared with menses and participants with severe premenstrual syndrome walked substantially fewer steps (average daily steps 10,283, SD 6277) during the luteal phase and menses compared with participants with no or low premenstrual syndrome (mean 11,694, SD 6458).

CONCLUSIONS

We demonstrate the feasibility of using an app-based approach to collect combined wearable device and questionnaire data on menstrual cycles. Dropouts in the early weeks of the study indicated that engagement efforts would need to be improved for larger studies. Despite the challenges of collecting wearable data on consecutive days, the data collected provided valuable biological insights, suggesting that the use of questionnaires in conjunction with wearable data may provide a more complete understanding of the menstrual cycle and its impact on daily life. The biological findings should motivate further research into understanding the relationship between the menstrual cycle and objective physiological measurements from sensor devices.

Measuring Self-Esteem with Expanded Format in a Fraction of Time: ESE-S and ESE-US

Despite the ubiquity of Likert format scales, they are not without problems-distorted dimensionality being one of the most serious. Zhang and Savalei proposed an alternative to Likert format called the Expanded format, in which each response option in the Likert scale is replaced with a series of complete statements. In response to their recent call, the purpose of the present study is to develop concise but valid Expanded format scales for the Rosenberg Self-Esteem Scale. Short (four-item) and ultra-short (two-item) scales were constructed, and their validity was examined in four studies. Results showed both new scales had good psychometric properties (dimensionality, reliability, and validity). Therefore, they would seem to be practical alternatives to the RSES for future research.

Human biomonitoring without in-person interaction: public health engagements during the COVID-19 pandemic and future implications

BACKGROUND

Public health initiatives, including human biomonitoring, have been impacted by unique challenges since the onset of the COVID-19 pandemic, compounding a decades-long trend of declining public participation. To combat low public participation rates, public health professionals often employ extensive engagement approaches including in-person interactions related to enrollment and sampling, success of which is an essential component of a statistically defensible study. The onset of the COVID-19 pandemic challenged public health programs to diversify engagement and sampling approaches, limiting direct interactions for the health and safety of the population. This study explores biomonitoring recruitment strategies through non-contact mechanisms and evaluate the application feasibility for population-based studies.

METHODS

The Iowa Biomonitoring Program at the State Hygienic Laboratory developed a human biomonitoring study that utilized a multifaceted, distance-based approach. Traditional techniques, such as mailed recruitment invitations and phone-based discussions, were coupled with internet-based surveys and self-collected, shipped urine and water samples. Participation rates were evaluated by employing different mailing methods, and the demographics of enrolled participants were examined.

RESULTS

This non-human contact approach achieved a nearly 14% participation rate among a rural population, well above our target rates. Our improved mailing strategy for targeting initially unresponsive participants yielded a significantly increase in the participation rates. The respondents were predominantly individuals with educational attainment of at least high school level. Among all the eligible participants, 83% submitted self-collected samples, a rate comparable to the National Health and Nutrition Examination Survey which involved in-person interviews.

CONCLUSIONS

The practice of engaging a rural population during the COVID-19 pandemic by transitioning from face-to-face interactions to a combination of mailing and internet-based approaches resulted in higher-than-expected participant recruitment and sample collection rates. Given the declining trend in the response rates for population-based survey studies, our results suggest conducting human biomonitoring without direct human interaction is feasible, which provides further opportunity to improve response rates and the relevance and reach of public health initiatives.

Protocol of a monocentric, double-blind, randomized, superiority, controlled trial evaluating the effect of in-prison OROS-methylphenidate vs. placebo treatment in detained people with attention-deficit hyperactivity disorder (BATIR)

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) is characterized by difficulty paying attention, poor impulse control, and hyperactive behavior. It is associated with several adverse health and social outcomes and leads to an increased risk of criminality and recidivism. Worldwide, ADHD is thus highly prevalent in prisons. However, ADHD treatment has been neglected in such environments. Stimulant medications such as osmotic-release oral system methylphenidate (OROS-MPH) are first-line treatments in the general population, but they are under-prescribed in prisons due to concerns about abuse, even though such claims are not empirically supported. This project aims to compare the efficacy of a 3-month in-prison OROS-MPH vs. placebo treatment on the severity of core ADHD symptoms and relevant in- and post-prison outcomes.

METHODS

This study is a phase III, double-blinded, randomized, superiority, controlled trial of OROS-MPH vs. placebo. After randomization, the participants will receive 3 months of treatment with OROS-MPH or placebo (1:1 ratio) while incarcerated. Upon release, all participants will be offered the treatment (OROS-MPH) for 1 year but will remain blinded to their initial study group. The study will be conducted at the Division of Prison Health, Geneva, Switzerland, among incarcerated men (n = 150). Measures will include (1) investigator-rated ADHD symptoms, (2) acute events collected by the medical and prison teams, (3) assessment of the risk of recidivism, (4) medication side effects, (5) medication adherence, (6) study retention, (7) health care/prison costs, and (8) 1-year recidivism. Analyses will include bivariable and multivariable modeling (e.g., regression models, mixed-effects models, survival analyses) and an economic evaluation (cost-benefit analysis).

DISCUSSION

We expect that early identification and treatment of ADHD in prison will be an important public health opportunity and a cost-effective approach that is likely to reduce the vulnerability of incarcerated individuals and promote pathways out of criminal involvement. The study will also promote standards of care for people with ADHD in prison and provide recommendations for continuity of care after release.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05842330 . Registered on June 5, 2023. Kofam.ch SNCTP000005388. Registered on July 17, 2023.

Participant and GP perspectives and experiences of screening for undiagnosed type 2 diabetes in community pharmacy during the Pharmacy Diabetes Screening Trial

BACKGROUND

The Pharmacy Diabetes Screening Trial (PDST) evaluated three approaches to screening for undiagnosed type 2 diabetes mellitus (T2DM) in community pharmacy: (1) paper-based risk assessment (AUSDRISK) alone; and AUSDRISK followed by a point of care test if AUSDRISK ≥ 12; with either (2) HbA1c; or (3) small capillary blood glucose Test (scBGT). This paper reports the perspectives and experiences of the pharmacy screening service of two key stakeholder groups: screening participants and general practitioners (GPs).

METHODS

All referred participants (n = 2242) received an online survey to determine the outcome of the referral, as well as their level of satisfaction with the service. In addition, a random sample of 2,989 (20%) of non-referred participants were surveyed to determine their overall experience and level of satisfaction with the service. GPs to whom participants were referred were contacted to establish if, since the date of the screening service, their patient had (1) been to see them; (2) had further tests performed (FBG, RBG, OGTT, HbA1c); or (3) been diagnosed with diabetes or prediabetes. Descriptive statistics were reported for quantitative data. Factors associated with visiting the GP following screening were assessed using multivariable logistic regression. Qualitative data were analysed using content analysis.

RESULTS

Response rates 16% (n = 369) and 17% (n = 520) were achieved for the three-month referred and non-referred participant surveys, respectively. Over 90% of respondents were very positive about the screening service (n = 784/853) and would recommend it to a family member or friend (n = 784/853). Participants also reported making significant improvements in diet and exercise, because of the screening. Among referred respondents, those who received a POC test were twice as likely to visit their GP compared to those who received a risk assessment only (OR 2.11 95% CI 1.46-3.06). GPs (15.8% response rate, n = 57/361) indicated that the referral worked well and that recommendations for follow-up care by the pharmacist were appropriate.

CONCLUSION

Opportunistic screening of individuals during routine encounters with the community pharmacy in a previously undiagnosed population has been shown to foster positive engagement with consumers and GPs, which may assist in reducing the burden of T2DM on the individual and the community.

Methods to increase response to postal and electronic questionnaires

BACKGROUND

Self-administered questionnaires are widely used to collect data in epidemiological research, but non-response reduces the effective sample size and can introduce bias. Finding ways to increase response to postal and electronic questionnaires would improve the quality of epidemiological research.

OBJECTIVES

To identify effective strategies to increase response to postal and electronic questionnaires.

SEARCH METHODS

We searched 14 electronic databases up to December 2021 and manually searched the reference lists of relevant trials and reviews. We contacted the authors of all trials or reviews to ask about unpublished trials; where necessary, we also contacted authors to confirm the methods of allocation used and to clarify results presented.

SELECTION CRITERIA

Randomised trials of methods to increase response to postal or electronic questionnaires. We assessed the eligibility of each trial using pre-defined criteria.

DATA COLLECTION AND ANALYSIS

We extracted data on the trial participants, the intervention, the number randomised to intervention and comparison groups and allocation concealment. For each strategy, we estimated pooled odds ratios (OR) and 95% confidence intervals (CI) in a random-effects model. We assessed evidence for selection bias using Egger's weighted regression method and Begg's rank correlation test and funnel plot. We assessed heterogeneity amongst trial odds ratios using a Chi2 test and quantified the degree of inconsistency between trial results using the I2 statistic.

MAIN RESULTS

Postal We found 670 eligible trials that evaluated over 100 different strategies of increasing response to postal questionnaires. We found substantial heterogeneity amongst trial results in half of the strategies. The odds of response almost doubled when: using monetary incentives (odds ratio (OR) 1.86; 95% confidence interval (CI) 1.73 to 1.99; heterogeneity I2 = 85%); using a telephone reminder (OR 1.96; 95% CI 1.03 to 3.74); and when clinical outcome questions were placed last (OR 2.05; 95% CI 1.00 to 4.24). The odds of response increased by about half when: using a shorter questionnaire (OR 1.58; 95% CI 1.40 to 1.78); contacting participants before sending questionnaires (OR 1.36; 95% CI 1.23 to 1.51; I2 = 87%); incentives were given with questionnaires (i.e. unconditional) rather than when given only after participants had returned their questionnaire (i.e. conditional on response) (OR 1.53; 95% CI 1.35 to 1.74); using personalised SMS reminders (OR 1.53; 95% CI 0.97 to 2.42); using a special (recorded) delivery service (OR 1.68; 95% CI 1.36 to 2.08; I2 = 87%); using electronic reminders (OR 1.60; 95% CI 1.10 to 2.33); using intensive follow-up (OR 1.69; 95% CI 0.93 to 3.06); using a more interesting/salient questionnaire (OR 1.73; 95% CI 1.12 to 2.66); and when mentioning an obligation to respond (OR 1.61; 95% CI 1.16 to 2.22). The odds of response also increased with: non-monetary incentives (OR 1.16; 95% CI 1.11 to 1.21; I2 = 80%); a larger monetary incentive (OR 1.24; 95% CI 1.15 to 1.33); a larger non-monetary incentive (OR 1.15; 95% CI 1.00 to 1.33); when a pen was included (OR 1.44; 95% CI 1.38 to 1.50); using personalised materials (OR 1.15; 95% CI 1.09 to 1.21; I2 = 57%); using a single-sided rather than a double-sided questionnaire (OR 1.13; 95% CI 1.02 to 1.25); using stamped return envelopes rather than franked return envelopes (OR 1.23; 95% CI 1.13 to 1.33; I2 = 69%), assuring confidentiality (OR 1.33; 95% CI 1.24 to 1.42); using first-class outward mailing (OR 1.11; 95% CI 1.02 to 1.21); and when questionnaires originated from a university (OR 1.32; 95% CI 1.13 to 1.54). The odds of response were reduced when the questionnaire included questions of a sensitive nature (OR 0.94; 95% CI 0.88 to 1.00). Electronic We found 88 eligible trials that evaluated over 30 different ways of increasing response to electronic questionnaires. We found substantial heterogeneity amongst trial results in half of the strategies. The odds of response tripled when: using a brief letter rather than a detailed letter (OR 3.26; 95% CI 1.79 to 5.94); and when a picture was included in an email (OR 3.05; 95% CI 1.84 to 5.06; I2 = 19%). The odds of response almost doubled when: using monetary incentives (OR 1.88; 95% CI 1.31 to 2.71; I2 = 79%); and using a more interesting topic (OR 1.85; 95% CI 1.52 to 2.26). The odds of response increased by half when: using non-monetary incentives (OR 1.60; 95% CI 1.25 to 2.05); using shorter e-questionnaires (OR 1.51; 95% CI 1.06 to 2.16; I2 = 94%); and using a more interesting e-questionnaire (OR 1.85; 95% CI 1.52 to 2.26). The odds of response increased by a third when: offering survey results as an incentive (OR 1.36; 95% CI 1.16 to 1.59); using a white background (OR 1.31; 95% CI 1.10 to 1.56); and when stressing the benefits to society of response (OR 1.38; 95% CI 1.07 to 1.78; I2 = 41%). The odds of response also increased with: personalised e-questionnaires (OR 1.24; 95% CI 1.17 to 1.32; I2 = 41%); using a simple header (OR 1.23; 95% CI 1.03 to 1.48); giving a deadline (OR 1.18; 95% CI 1.03 to 1.34); and by giving a longer time estimate for completion (OR 1.25; 95% CI 0.96 to 1.64). The odds of response were reduced when: "Survey" was mentioned in the e-mail subject (OR 0.81; 95% CI 0.67 to 0.97); when the email or the e-questionnaire was from a male investigator, or it included a male signature (OR 0.55; 95% CI 0.38 to 0.80); and by using university sponsorship (OR 0.84; 95%CI 0.69 to 1.01). The odds of response using a postal questionnaire were over twice those using an e-questionnaire (OR 2.33; 95% CI 2.25 to 2.42; I2 = 98%). Response also increased when: providing a choice of response mode (electronic or postal) rather than electronic only (OR 1.76 95% CI 1.67 to 1.85; I2 = 97%); and when administering the e-questionnaire by computer rather than by smartphone (OR 1.62 95% CI 1.36 to 1.94).

AUTHORS' CONCLUSIONS

Researchers using postal and electronic questionnaires can increase response using the strategies shown to be effective in this Cochrane review.

Performance of Orthopaedic Shoulder and Elbow Surgeons on a Biostatistical Knowledge Examination

Background

The objective of this study is to evaluate the biostatistical interpretation abilities of fellowship trained orthopaedic surgeons.

Methods

A cross-sectional survey was administered to orthopaedic surgeon members of the American Shoulder and Elbow Surgeons (ASES), assessing orthopaedic surgeon attitudes towards biostatistics, confidence in understanding biostatistics, and ability to interpret biostatistical measures on a multiple-choice test.

Results

A 4.5% response rate was achieved with 55 complete survey responses. The mean percent correct was 55.2%. Higher knowledge test scores were associated with younger age and fewer years since board exam completion (p ≤ 0.001). Greater average number of publications per year correlated with superior statistical interpretation (p=0.009). Respondents with higher self-reported confidence were more likely to accurately interpret results (p ≤ 0.017). Of the respondents, 93% reported frequently using statistics to form medical opinions, 98% answered that statistical competency is important in the practice of orthopaedic surgery, and 80% were eager to continue learning biostatistics.

Conclusions

It is concerning that fellowship-trained shoulder and elbow surgeons, many of whom frequently publish or are reviewing scientific literature for publication, are scoring 55.2% correctly on average on this biostatistical knowledge examination. Surgeons that are further from formal statistical knowledge training are more likely to have lower biostatistical knowledge test scores. Respondents who published at the highest rate were associated with higher scores. Continuing medical education in biostatistics may be beneficial for maintaining statistical knowledge utilised in the current literature.

Venous thromboembolism prophylaxis for hospitalized adult patients: a survey of US health care providers on attitudes and practices

Background

Venous thromboembolism (VTE) is a leading cause of preventable mortality among hospitalized patients, but appropriate risk assessment and thromboprophylaxis remain underutilized or misapplied.

Objectives

We conducted an electronic survey of US health care providers to explore attitudes, practices, and barriers related to thromboprophylaxis in adult hospitalized patients and at discharge.

Results

A total of 607 US respondents completed the survey: 63.1% reported working in an academic hospital, 70.7% identified as physicians, and hospital medicine was the most frequent specialty (52.1%). The majority of respondents agreed that VTE prophylaxis is important (98.8%; 95% CI: 97.6%-99.5%) and that current measures are safe (92.6%; 95% CI: 90.2%-94.5%) and effective (93.8%; 95% CI: 91.6%-95.6%), but only half (52.0%; 95% CI: 47.9%-56.0%) believed that hospitalized patients at their institution are on appropriate VTE prophylaxis almost all the time. One-third (35.4%) reported using a risk assessment model (RAM) to determine VTE prophylaxis need; 44.9% reported unfamiliarity with RAMs. The most common recommendation for improving rates of appropriate thromboprophylaxis was to leverage technology. A majority of respondents (84.5%) do not reassess a patient's need for VTE prophylaxis at discharge, and a minority educates patients about the risk (16.2%) or symptoms (18.9%) of VTE at discharge.

Conclusion

Despite guideline recommendations to use RAMs, the majority of providers in our survey do not use them. A majority of respondents believed that technology could help improve VTE prophylaxis rates. A majority of respondents do not reassess the risk of VTE at discharge or educate patients about this risk of VTE at discharge.

Evaluation of response to incentive recruitment strategies in a social media-based survey

Objective

This study aimed to examine varying incentives on acceptance to participate in an online survey on social media and to identify related demographic factors.

Methods

The study used Facebook and targeted its users aged 18 to 24 years in the United States. During recruitment, participants were randomized to one of the three types of incentives for survey completion, (1) a $5 gift card, (2) a lottery for a $200 gift card, and (3) a $5 gift card plus a lottery for a $200 gift card. Acceptance rates for survey participation were compared across three incentives using percentages, 95% logit-transformed confidence intervals, and Pearson's chi-squared tests. The survey asked about cognition and behaviors around smoking and vaping.

Results

The ads had 1,782,931 impressions, 1,104,139 reaches, and 11,878 clicks. The average ad frequency was 1.615, and the click-through rate was 0.67%. Males clicked less than females when seeing the ads. The acceptance rates for the three incentives were 63.7%, 37.2%, and 64.6%, respectively. A Chi-square test confirmed that the lottery-only group had a lower acceptance rate compared to those guaranteed an incentive, including the gift card group and the gift card and lottery group. Further analyses indicated that males did not opt into the survey as often as females when given the lottery-only incentive option, and those who did not meet their financial expenses opted into the survey more often than those who had more money than their expenses when given the lottery-only incentive option.

Conclusions

This study suggests that incentives guaranteed to all participants, even if the incentive's value is small, may lead to higher acceptance rates compared to a lottery for a greater incentive in social media-based surveys.

Data Collection in Times of Pandemic: A Self-Study and Revisit of Research Practices During a Crisis

COVID-19 as a global pandemic has greatly disrupted research, not only in terms of the practicality of research activities such as data collection, but also in data quality. Using self-study in form of duoethnography method for reflecting on research practice, this article reviews and reflects on the practices of remote data collection during the pandemic and further revisits additional issues brought about by these practices and concerns. One key observation from this self-study is the prevalence of practical challenges, particularly those related to participant access, that overshadows the potential advantages of remote data collection as well as other challenges. This challenge results in researchers' reduced control of the research process and also a requirement for more flexibility, greater sensitivity toward the participants and research skills for the researchers. We also observe greater conflation of quantitative and qualitative data collection and the emergence of triangulation as the main strategy to offset potential threats to data quality. This article concludes by calling for more discussions on several areas that feature scarce discussion in literature, including potential rhetoric importance assigned to data collection, adequacy of triangulation to safeguard data quality, and the potential difference between COVID-19's impact on quantitative and qualitative research.

The anticoagulation length of therapy and risk of new adverse events in venous thromboembolism (ALTERNATIVE) study: Design and survey results

The Anticoagulation Length of Therapy and Risk of New Adverse Events In Venous Thromboembolism (ALTERNATIVE) study was designed to compare the benefits and harms of different treatment options for extended treatment of venous thromboembolism (VTE). In this paper, we describe the study cohort, survey data collection, and preliminary results. We identified 39,605 adult patients (age ≥ 18 years) from two large integrated health care delivery systems who were diagnosed with incident VTE and received initial anticoagulation therapy of 3 months or longer. A subset of the cohort (12,737) was invited to participate in a survey. Surveys were completed in English, Spanish or Mandarin via a mailed questionnaire, an online secure web link, or telephone. The survey domains included demographics, personal medical history, anticoagulant treatment history, anticoagulant treatment satisfaction, health-related quality of life and health literacy. A total of 5,017 patients participated in the survey for an overall response rate of 39.4%. The mean (SD) age of the survey respondents was 63.0 (14.5) years and self-reported race was 76.0% White/European, 11.1% Black/African American, and 3.8% Asian/Pacific Islander and 14.0% reported Hispanic ethnicity. Sixty percent of respondents completed the web survey, while 29.0% completed the mail-in paper survey, and 11.0% completed the survey via telephone. The ALTERNATIVE Study will address knowledge gaps by comparing several treatment alternatives for the extended management of VTE so that this information could be used by patients and clinicians to make more informed, patient-centered treatment choices.

Possible Measures to Improve Both Participation and Response Quality in Japan’s National Health and Nutrition Survey: Results from a Workshop by Local Government Personnel in Charge of the Survey

Increasing participation rates are crucial to ensure the representativeness of national survey results of the population. This study aimed to identify measures that could be taken by local government personnel in charge of the National Health and Nutrition Survey (NHNS), Japan, to improve participation rates. The subjects were twenty-one health personnel who worked in 19 local governments and participated in the training course at the National Institute of Public Health. Qualitative data were collected through a workshop. They discussed the problems that seem to affect participation rates and identified possible solutions. The contents were coded and grouped to create categories, using the Jiro Kawakita (KJ) method. For data analysis, researchers combined and reviewed all codes and categories. The measures that could improve participation rates were divided into the following 12 categories: 1. standardization of survey methods, 2. investigator skills, 3. survey organization, 4. venue setting, 5. accessing target households, 6. time of survey, 7. responses during the investigation, 8. confirming meal contents reported in the nutritional intake status survey, 9. rewards/incentives, 10. possible rewards, 11. feedback on survey results, and 12. survey practices during the COVID-19 pandemic. These findings represent viable initiatives for local health personnel to increase participation rates for the NHNS.

Mixed-methods process evaluation of a residence-based SARS-CoV-2 testing participation pilot on a UK university campus during the COVID-19 pandemic

BACKGROUND

Regular testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is an important strategy for controlling virus outbreaks on university campuses during the COVID-19 pandemic but testing participation rates can be low. The Residence-Based Testing Participation Pilot (RB-TPP) was a novel intervention implemented at two student residences on a large UK university campus over 4 weeks. The aim of the pilot was to increase the frequency of asymptomatic SARS-CoV-2 saliva testing onsite. This process evaluation aimed to determine whether RB-TPP was implemented as planned and identify implementation barriers and facilitators.

METHODS

A mixed-methods process evaluation was conducted alongside the RB-TPP. Evaluation participants were students (opting in, or out of RB-TPP) and staff with a role in service provision or student support. Monitoring data were collected from the intervention delivery team and meeting records. Data were collected from students via online survey (n = 152) and seven focus groups (n = 30), and from staff via individual interviews (n = 13). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the 'Capability, Opportunity, Motivation-Behaviour' (COM-B) behaviour change framework.

RESULTS

Four hundred sixty-four students opted to participate in RB-TPP (98% of students living onsite). RB-TPP was implemented broadly as planned but relaxed social distancing was terminated early due to concerns relating to national escalation of the COVID-19 Delta variant, albeit testing continued. Most students (97.9%) perceived the period of relaxed social distancing within residences positively. The majority engaged in asymptomatic testing (88%); 46% (52% of testers) were fully compliant with pre-determined testing frequency. Implementation was facilitated by convenience and efficiency of testing, and reduction in the negative impacts of isolation through opportunities for students to socialise. Main barriers to implementation were perceived mixed-messages about the rules, ambivalent attitudes, and lack of adherence to COVID-19 protective measures in the minority.

CONCLUSIONS

This process evaluation identifies factors that help or hinder the success of university residence-based outbreak prevention and management strategies. RB-TPP led to increased rates of SARS-CoV-2 testing participation among students in university residences. Perceived normalisation of university life significantly enhanced student mental wellbeing. The complexity and challenge generated by multiple lines of communication and rapid adaptions to a changing pandemic context was evident.

TRIAL REGISTRATION NUMBER

UKAS 307727-02-01; Pre-results.

CLINICALTRIALS

gov Identifier: NCT05045989 ; post-results (first posted, 16/09/21).

ETHICAL APPROVAL

Faculty of Medicine & Health Sciences Research Ethics Committee, University of Nottingham (Ref: FMHS 96-0920).

Consumers’ Perspectives and Behaviors towards Corporate Social Responsibility—A Cross-Cultural Study

This study measured consumers’ perspectives and behaviors with respect to corporate social responsibility (CSR). Specifically, we explored the components of CSR, including CSR aimed towards the environment, society, customers, employees, suppliers, and shareholders. We also examined the impact of CSR practices on brand attitude and purchase intention. The study surveyed 616 consumers across three locations, with detailed questionnaires in four languages. A total of 564 samples (186 from Vietnam, 189 from Indonesia, and 189 from Taiwan) qualified for data analysis. Additionally, statistics software including LISREL 8.8, STATISTICA 10, and MINITAB 19 were utilized to evaluate our hypotheses and construct a structural model. The results indicated that the consumers across the three areas were not concerned about CSR aimed towards shareholders, while all consumers considered CSR aimed towards themselves. Vietnamese customers prioritized a company’s care for its employees, while both Indonesian and Taiwanese consumers concentrated on the environment and society. In addition, suppliers’ benefits and rights attracted Indonesians’ attention. Furthermore, CSR had a positive significant impact on brand reputation in all three cultures. However, while CSR had a positive influence on customer purchase intention in Indonesia and Taiwan, it did not in Vietnam.

Improving Electronic Survey Response Rates Among Cancer Center Patients During the COVID-19 Pandemic: Mixed Methods Pilot Study

BACKGROUND

Surveys play a vital role in cancer research. During the COVID-19 pandemic, the use of electronic surveys is crucial to improve understanding of the patient experience. However, response rates to electronic surveys are often lower compared with those of paper surveys.

OBJECTIVE

The aim of this study was to determine the best approach to improve response rates for an electronic survey administered to patients at a cancer center during the COVID-19 pandemic.

METHODS

We contacted 2750 patients seen at Moffitt Cancer Center in the prior 5 years via email to complete a survey regarding their experience during the COVID-19 pandemic, with patients randomly assigned to a series of variations of prenotifications (ie, postcard, letter) or incentives (ie, small gift, modest gift card). In total, eight combinations were evaluated. Qualitative interviews were conducted to understand the level of patient understanding and burden with the survey, and quantitative analysis was used to evaluate the response rates between conditions.

RESULTS

A total of 262 (9.5%) patients completed the survey and 9 participated in a qualitative interview. Interviews revealed minimal barriers in understanding or burden, which resulted in minor survey design changes. Compared to sending an email only, sending a postcard or letter prior to the email improved response rates from 3.7% to 9.8%. Similarly, inclusion of an incentive significantly increased the response rate from 5.4% to 16.7%, especially among racial (3.0% to 12.2%) and ethnic (6.4% to 21.0%) minorities, as well as among patients with low socioeconomic status (3.1% to 14.9%).

CONCLUSIONS

Strategies to promote effective response rates include prenotification postcards or letters as well as monetary incentives. This work can inform future survey development to increase response rates for electronic surveys, particularly among hard-to-reach populations.

Using a behavioural approach to explore the factors that affect questionnaire return within a clinical trial: a qualitative study based on the theoretical domains framework

Objectives

To identify barriers and enablers to participant retention in trials requiring questionnaire return using the theoretical domains framework (TDF).

Study design and setting

We identified and subsequently invited participants who did not return at least one questionnaire during their participation in a clinical trial for one-to-one semi-structured telephone interviews. We used a behavioural framework (TDF) to explore whether any of the behavioural domains (eg, beliefs about consequences, emotion) affected questionnaire return. Thereafter, we generated a series of belief statements which summarised the content of participants’ main responses and coded these under separate themes.

Participants

We distributed invites to 279 eligible individuals and subsequently interviewed 9 participants who took part in the C-Gall trial. The C-Gall trial required participants to complete five postal questionnaires during their participation.

Results

Nine participants were interviewed. We developed 7 overarching themes which were relevant for returning postal questionnaires and identified both barriers and enablers from 11 core domains: knowledge; beliefs about consequences; environmental context and resources; reinforcement; emotion; beliefs about capabilities; behavioural regulation; social professional role and identity; skills; intentions and goals. Relevant content coded under these salient domains were categorised into seven key themes: unclear expectations of trial participation, personal attributes for questionnaire return, commitment to returning questionnaires given other priorities, sources of support in returning the questionnaires, individual preferences for presentation mode and timing of the questionnaires, internal and external strategies to encourage questionnaire return and the significance of questionnaire non-return.

Conclusion

We demonstrate how a behavioural approach may be useful for clinical trials associated with significant participation burden (e.g. trials that require multiple questionnaire responses), acting as the essential groundwork for the development of appropriate evidence-based solutions to combat retention issues.

Trial registration number

55215960; Pre-results.

A crossed-disciplinary evaluation of parental perceptions surrounding pediatric non-invasive brain stimulation research

PURPOSE –

Recruitment for pediatric non-invasive brain stimulation (NIBS) studies is often challenged by low enrollment. Understanding parental perceptions regarding NIBS is crucial to develop new communication strategies to increase enrollment.

DESIGN/METHODOLOGY/APPROACH –

Integrating a crossed-disciplinary approach, the authors conducted a survey at the 2018 Minnesota State Fair querying the perception of risk and preferences of current and future parents associated with pediatric NIBS research. The survey consisted of 28 closed-text questions including demographics, photographs portraying NIBS, terminologies and factors related to NIBS studies.

FINDINGS –

Complete surveys were analyzed from 622 parent participants. A significant number of participants (42.8%) perceived the photographs of NIBS as "risky." Additionally, 65.43% perceived the term "Non-invasive brain therapy" as not risky, a word combination not currently being used when recruiting potential participants. Over 90% (561/622) of participants chose the photograph of child-friendly MRI suite.

RESEARCH LIMITATIONS/IMPLICATIONS –

Although this survey identified aspects crucial in recruitment for pediatric NIBS research, there were limitations. For example, the authors did not record the sex or demographic distribution (e.g. rural versus urban setting) of the participants. These factors may also influence recruitment messaging.

ORIGINALITY/VALUE –

For important medical research to impact and improve the lives of the potential remedies, participation by the public in clinical trials is necessary. Often the general public perceives the trials as risky as a result of poor marketing communication recruitment material. This study sought to be understood if how the message is encoded has an impact on the decoding by the receiver.

Eliciting Willingness and Beliefs towards Participation in Genetic Psychiatric Testing in Black/African American Mothers at Risk for Depression

Black/African American women are at high risk for depression, yet are underrepresented in psychiatric genetic research for depression prevention and treatment. Little is known about the factors that influence participation in genetic testing for Black/African American women at risk. The purpose of this study was to elicit the beliefs that underlie participation in genetic testing for depression in Black/African American mothers, a subgroup at high risk. Willingness to participate in genetic testing procedures was also determined. A qualitative, descriptive design was employed. Exactly 19 mothers aged 21–42 completed open-ended questionnaires. Directed content and descriptive analyses of the text were conducted based on the Theory of Planned Behavior. Salient beliefs included: behavioral advantages—diagnosing/detecting depression (31.6%), finding cure/treatment (21.1%); disadvantages—not finding follow-up treatment/help (21.1%); salient referents, who approves—family members (47.4%), agencies/organizations (26.3%); who disapproves—church associates (21.1%). Control beliefs included: barriers—unpleasant/difficult testing procedures (42.1%), limited knowledge about the purpose of testing (26.3%); facilitator—a convenient location (21.1%). Most mothers (89.5%) indicated willingness to participate in testing. Interventions can target families, address barriers, emphasize future benefits, and use convenient locations and community-based participatory research methods. Policies can address social determinants of participation to increase inclusion of these mothers in psychiatric genetic research.

Collecting, exploring and sharing personal data: Why, how and where

New, multi-channel personal data sources (like heart rate, sleep patterns, travel patterns, or social activities) are enabled by ever increased availability of miniaturised technologies embedded within smartphones and wearables. These data sources enable personal self-management of lifestyle choices (e.g., exercise, move to a bike-friendly area) and, on a large scale, scientific discoveries to improve health and quality of life. However, there are no simple and reliable ways for individuals to securely collect, explore and share these sources. Additionally, much data is also wasted, especially when the technology provider ceases to exist, leaving the users without any opportunity to retrieve own datasets from “dead” devices or systems. Our research reveals evidence of what we term human data bleeding and offers guidance on how to address current issues by reasoning upon five core aspects, namely technological, financial, legal, institutional and cultural factors. To this end, we present preliminary specifications of an open platform for personal data storage and quality of life research. The Open Health Archive (OHA) is a platform that would support individual, community and societal needs by facilitating collecting, exploring and sharing personal health and QoL data.

Evaluation of the Sexual Health Behaviors of Black Male Adolescents and Young Adults Through Social Media Platforms: Web-Based Survey Study

Background

Social media platforms such as Facebook, Instagram, and Twitter, which have millions of users who interact and communicate every day, have been effective in promoting sexual health interventions and in disseminating reproductive health education. They have also been shown to be useful in health promotion and have been used to track several key metrics (eg, comments, posts) among users of all demographics. However, there is a lack of research on the impact and reach of these social media platforms as a community-based tool for disseminating sexual health information and for increasing engagement among Black adolescents and young adults, which is a targeted high-risk population.

Objective

The purpose of this study was to determine the social media platforms and banner advertisements that affected engagement among Black male adolescents and young adults in participating in web-based health surveys.

Methods

A web-based survey was conducted from March 2019 to July 2019 to assess sexual health and health behaviors in a convenience sample of Black male adolescents and young adults in the age range of 18-24 years (N=170). Social media metrics from Facebook, Instagram, and Twitter were monitored. This cross-sectional survey comprised several categories, including basic personal information, drug-related risk behaviors, health care, sexual reproductive health questions, attitudes, norms, and perceived control, mental health, violence-related risk behaviors, and social media preferences.

Results

Social media advertisements on the Black Male Opinion survey reached approximately 146,412 individuals. Our primary finding of the web-based survey engagement was that referral (eg, group chat, indirect social media sharing) led to as the greatest proportion of recruitment, with Twitter and YouTube as the preferred sites to receive sexual health information.

Conclusions

Recognizing the variety of technologies being used among Black male young adults and adolescents can help the community, researchers, and health care providers understand the web-based engagement of this high-risk population. This information may also promote culturally sensitive, customized marketing on sexual health information for this population.

Unconditional and conditional monetary incentives to increase response to mailed questionnaires: A randomized controlled study within a trial (SWAT)

RATIONALE, AIMS, AND OBJECTIVES

High response rates to research questionnaires can help to ensure results are more representative of the population studied and provide increased statistical power, on which the study may have been predicated. Improving speed and quality of response can reduce costs.

METHOD

We conducted a randomized study within a trial (SWAT) to assess questionnaire response rates, reminders sent, and data completeness with unconditional compared with conditional monetary incentives. Eligible individuals were mailed a series of psychological questionnaires as a follow-up to a baseline host trial questionnaire. Half received a £5 gift voucher with questionnaires (unconditional), and half were promised the voucher after returning questionnaires (conditional).

RESULTS

Of 1079 individuals, response rates to the first follow-up questionnaire were 94.2% and 91.7% in the unconditional and conditional monetary incentive groups, respectively (OR 1.78; 95% CI, 0.85-3.72). There were significantly greater odds of returning repeat questionnaires in the unconditional group at 6 months (OR 2.97; 95% CI, 1.01-8.71; .047) but not at 12 months (OR 1.12; 95% CI, 0.44-2.85). Incentive condition had no impact at any time point on the proportion of sent questionnaires that needed reminders. Odds of incomplete questionnaires were significantly greater at 3 months in the unconditional compared with the conditional incentive group (OR 2.45; 95% CI, 1.32-4.55; .004).

CONCLUSIONS

Unconditional monetary incentives can produce a transitory greater likelihood of mailed questionnaire response in a clinical trial participant group, consistent with the direction of effect in other settings. However, this could have been a chance finding. The use of multiple strategies to promote response may have created a ceiling effect. This strategy has potential to reduce administrative and postage costs, weighed against the cost of incentives used, but could risk compromising the completeness of data.

The effect of monetary incentive on survey response for vulnerable children and youths: A randomized controlled trial

AIM

In surveys non-responders may introduce bias and lower the validity of the studies. Ways to increase response rates are therefore important. The purpose of the study was to investigate if an unconditional monetary incentive can increase the response rate for vulnerable children and youths in a postal questionnaire survey.

METHODS

The study was designed as a randomized controlled trial. The study population consisted of 262 children and youth who participated in an established intervention study aimed at creating networks for different groups of vulnerable children and youths. The mean age of the participants was 16.7 years (range 11-28) and 67.9% were female. The questionnaire was adapted to three different age groups and covered different aspects of the participants' life situation, including the dimensions from the Strengths and Difficulties Questionnaire (SDQ). In the follow-up survey, participants were randomly allocated to two groups that either received a €15 voucher for a supermarket together with the questionnaire or only received the questionnaire. We used Poisson regression to estimate the differences in response rate (Rate Ratio RR) between the intervention group and the control group.

RESULTS

The response rate was 75.5% in the intervention group and 42.9% in the control group. The response rate in the intervention group was significantly higher than in the control group when adjusting for age and gender (Rate Ratio, RR 1.73; 95% CI 1.38-2.17). We did not find any significant differences in scales scores between the two groups for the five scales of the SDQ. In stratified analyses, we found the effect of the incentive to be higher for males (RR 2.81; 95% CI 1.61-4.91) than for females (1.43; 95% CI 1.12-1.84).

CONCLUSIONS

Monetary incentives can increase the response rate for vulnerable children and youths in surveys.

TRIAL REGISTRATION

The trial was retrospectively registered at ClinicalTrials.gov Identifier: NCT01741675.

Can Citizen Science using social media inform sanitation planning?

Improving the sanitation situation in a community that relies on on-site sanitation requires information about the quantity and quality of faecal sludge (FS) produced. Existing tools for data collection about FS characteristics are either imprecise or very costly. As information and communication technologies are becoming more available in low-income countries, Citizen Science is becoming an option for the collection of sanitation data. This study used an online survey distributed via social media to predict FS characteristics (Total Solids (TS), Total Suspended Solids (TSS), Volatile Suspended Solids (VSS), Chemical Oxygen Demand (COD) and Sludge Volume Index (SVI)) at 40 households in Blantyre, Malawi. Furthermore, the study investigated whether and how an online survey could yield cost-effective and representative information about the sanitation situation at the household level. Facebook and WhatsApp both introduced a bias towards higher income households as low-income households still lack access to smartphones and internet. WhatsApp (€1.01/reply) was significantly cheaper than Facebook (€3.00/reply) and conventional data generation with household interviewers (€1.47-2.20/reply). Monetary incentives generated more replies than pure social messaging. TSS, VSS and COD were significantly correlated to TS. The slope of the regression line of COD to TS (0.97) was similar to one reported for Uganda (0.88), suggesting that the ratio of COD to TS might be independent of the location. Statistically significant median differences of TS concentrations were found for the survey parameters "system type" and "solid waste", making these parameters candidates for predictors of FS characteristics. The sample size was too small for the other survey parameters to detect any differences statistically. Overall, using social media in a Citizen Science approach appears to be a promising new tool for FS characterization. In the current form, it can probably not replace other data collection tools, but rather complement them as a cost-efficient method to gain an initial assessment. Besides sanitation planning, social media and the Citizen Science approach could be employed for data collection in various fields of development cooperation.

A cross-sectional survey examining motivation and beliefs to participating in a web-based prospective cohort study on nutrition and health among individuals with a low socioeconomic status

Background

Prospective cohort studies may support public health efforts in reducing health inequalities. However, individuals with a low socioeconomic status (SES) are generally underrepresented in health research. This study aimed to examine the intention and determinants of intention of individuals with a low SES towards participation in a Web-based prospective project on nutrition and health (NutriQuébec) in order to develop recruitment and retention strategies.

Methods

A cross-sectional survey based on the Theory of planned behaviour was conducted in the Province of Québec, Canada. Low SES individuals (high school or less and annual household income < $55,000 CAN) were recruited through a Web panel of a polling firm to assess intention, attitude, subjective norm and perceived behavioural control (PBC) towards participation in the NutriQuébec project. Linear regression and logistic regression analyses were conducted.

Results

Mean age of respondents (184 women, 141 men) was 57.6 y (SD = 13.6). Attitude (ß = 0.54, 95%CI: 0.41–0.68) and PBC (ß = 0.50, 95%CI: 0.37–0.63) were significantly associated with intention. Participants who agreed that participating in the study would contribute to an improvement in 1) collective health (odds ratio [OR] = 2.15, 95%CI: 1.27–3.64) and in 2) one’s lifestyle habits (OR = 1.70, 95%CI: 1.04–2.78) were more likely to express positive intention compared to participants who did not agree with these statements. Participants who agreed to participate in the study even 1) in the absence of a financial incentive (OR = 1.43, 95%CI: 1.04–1.99) and even 2) if the completion of questionnaires took up to two hours (OR = 1.78, 95%CI: 1.27–2.48) were also more likely to express high intention. Receiving a personalized brief health assessment (OR = 1.61, 95%CI: 1.13–2.30) and the use of simple questions in the questionnaires (OR = 1.54, 95%CI: 1.05–2.25) were facilitating factors associated with high intention. Participants believing that participation would be too time-consuming were less likely to have positive intention (OR = 0.57, 95%CI: 0.43–0.75).

Conclusions

The development of a positive attitude and a high PBC towards participation in the NutriQuébec project will be necessary to obtain representative data of low SES adults.

Beliefs Related to Participation in a Large Web-Based Prospective Survey on Diet and Health Among Individuals With a Low Socioeconomic Status: Qualitative Study

BACKGROUND

NutriQuébec is a Web-based prospective study on the relationship between diet and health as well as the impact of food-related health policies in the adult population of Québec, Canada. Recruitment and retention of individuals with a low socioeconomic status (SES) in such a study are known to be challenging, yet critical for achieving representativeness of the entire population.

OBJECTIVE

This study aimed to identify the behavioral, normative, and control beliefs of individuals with a low SES regarding participation in the NutriQuébec project and to identify their preferences regarding recruitment methods.

METHODS

A total of four focus groups were conducted in community centers located in low-income areas of Québec City, Canada. On the basis of the theory of planned behavior, participants' beliefs associated with attitude, subjective norm, and perceived behavioral control regarding hypothetical participation in the NutriQuébec project were identified. Focus groups were recorded, transcribed, and coded by two analysts.

RESULTS

Participants (16 men and 12 women) were aged between 28 and 72 years, and a majority of the participants had an annual household income of Can $19,999 or less. The main perceived advantages of participating in the NutriQuébec project were contributing to improved collective health and supporting research. The only disadvantage identified was the risk of having to fill out too many questionnaires. Participants could not, in general, identify persons from their entourage who would approve or disapprove their participation in the study. The main facilitators identified were obtaining a brief health assessment and the ability to complete questionnaires in a way that is not Web-based. The main barrier was the lack of internet access. The preferred means of recruitment were through social media, television, and community centers.

CONCLUSIONS

These results provide insightful information regarding the best methods and messages to use in order to recruit and retain individuals with a low SES in a population-based prospective study on lifestyle and health on the internet.

Reflections on grief research interview participation

This article offers a reflection of two studies conducted with bereaved college students and the feedback on motivations to be interviewed about their grief experiences. Although this was not the initial intent of the original mixed methods study, the unexpected and overwhelming response of students who signed up to interview about their grief experiences warranted an additional examination to explore this surprising phenomenon. Responses in 45 interviews centered on motivations of wanting to share their experiences, feeling safe sharing their experiences, and wanting to help other students who may be experiencing grief. Implications and recommendations for future research are provided.

Effect of prepaid and promised financial incentive on follow-up survey response in cigarette smokers: a randomized controlled trial

BACKGROUND

Monetary incentive is often used to increase response rate in smokers' survey, but such effect of prepaid and promised incentives in a follow-up survey is unknown. We compared the effect of different incentive schemes on the consent and retention rates in a follow-up survey of adult cigarette smokers.

METHODS

This was a randomized controlled trial (RCT) in Hong Kong, China. Smokers who completed a non-incentivized baseline telephone smoking survey were invited to a 3-month follow-up, with randomization into (1) the control group (no incentive), (2) a promised HK$100 (US$12.8) incentive upon completion, (3) a promised HK$200 (US$25.6) incentive upon completion, or (4) a prepaid HK$100 incentive plus another promised HK$100 incentive ("mixed incentive"). Crude risk ratios from log-binomial regression models were used to assess if the 3 incentive schemes predicted higher rates of consent at baseline or retention at 3-month than no incentive.

RESULTS

In total, 1246 smokers were enrolled. The overall consent and retention rates were 37.1 and 23.0%, respectively. Both rates generally increased with the incentive amount and offer of prepaid incentive. The mixed incentive scheme marginally increased the retention rate versus no incentive (26.8% vs 20.3%; risk ratio (RR) = 1.32; 95% CI: 1.00-1.76; P = 0.053), but not the consent rate (RR = 1.13; 95% CI: 0.93-1.38; P = 0.22). Among the consented participants, approximately 50% in the mixed incentive group received the mailed prepaid incentive, who achieved a higher retention rate than the group without incentives (82.8% vs 56.1%; RR = 1.48; 95% CI: 1.21-1.80; P < 0.01).

CONCLUSION

The mixed incentive scheme combining the prepaid and promised incentive was effective to increase the follow-up retention rate by 48%. We recommend this mixed incentive scheme to increase the follow-up retention rate. More efficient methods of delivering the incentive are needed to maximize its effects.

TRIAL REGISTRATION

U.S. Clinical Trials registry (clinicaltrials.gov, retrospectively registered, reference number: NCT03297866 ).

Small Social Incentives Did Not Improve the Survey Response Rate of Patients Who Underwent Orthopaedic Surgery: A Randomized Trial

BACKGROUND

The generalizability of data derived from patient-reported outcome measures (PROMs) depends largely on the proportion of the relevant population that completes PROM surveys. However, PROM survey responses remain low, despite efforts to increase participation. Social incentives, such as the offer to make a charitable donation on behalf of the survey respondent, have generally not been effective where online surveys are concerned, but this has not been extensively tested in medicine.

QUESTIONS/PURPOSES

(1) Do personalized social incentives increase response rates or response completeness for postoperative PROM surveys in an orthopaedic population? (2) Are there demographic factors associated with response and nonresponse to postoperative PROM surveys? (3) Are some demographic factors associated with increased response to social incentive offers?

METHODS

Participants were selected from an institutional orthopaedics database. Patients were older than 18 years, had an email address on file, and had undergone one of the following procedures 1 to 2 years ago: Achilles tendon repair, ACL reconstruction, meniscectomy, hip arthroscopy, TKA, or THA. Of 4685 eligible patients, 3000 (64%) were randomly selected for inclusion in the study. Participants were randomized to one of four groups: (1) control: no incentive (n = 750); (2) patient donation: offer of a USD 5 donation to provide medical supplies to a pediatric orthopaedic patient (n = 751); (3) research donation: offer of a USD 5 donation to a procedure-specific research program (n = 749); or (4) explanation: explanation that response supports quality improvement (n = 750). The four groups did not differ regarding patient age, gender, race, procedure type, or time since procedure. All patients were sent an email invitation with the same PROM survey link. The proportion of patients who responded (defined here as the response rate) was measured at 4 weeks and compared between intervention groups. We used a logistic regression analysis to identify demographic factors associated with response while controlling for confounding variables and performed subgroup analyses to determine any demographic factors associated with increased response to social incentives.

RESULTS

There was no difference in the overall response rate (research donation: 49% [353 of 725], patient donation: 45% [333 of 734], control: 45% [322 of 723], explanation: 44% [314 of 719]; p = 0.239) or response completeness (research donation: 89% [315 of 353], patient donation: 90% [301 of 333], control: 89% [287 of 322], explanation: 87% [274 of 314]; p = 0.647) between the four groups. Women (odds ratio [OR], 1.175; p = 0.042), older patients (< 58 years: OR, 1.016 per 1-year increase; p = 0.001; 58-64 years: OR, 1.023 per 1-year increase; p < 0.001; > 64 years: OR, 1.021 per 1-year increase; p < 0.001), and white patients (OR 2.034 compared with black patients, p < 0.001) were slightly more likely to respond, after controlling for potential confounding variables such as gender, age, race, and procedure type. In subgroup analyses, men (research donation: 49% [155 of 316], patient donation: 45% [146 of 328], control: 40% [130 of 325], explanation: 39% [127 of 325]; p = 0.041) and patients younger than 58 years (research donation: 40% [140 of 351], control: 35% [130 of 371], patient donation: 32% [113 of 357], explanation: 27% [93 of 340]; p = 0.004) were slightly more likely to respond to the research donation than those with other interventions were.

CONCLUSIONS

Despite small effects in specific subgroups, personalized social incentives did not increase the overall response to postoperative orthopaedic surveys. Novel and targeted strategies will be necessary to reach response thresholds that enable healthcare stakeholders to use PROMs effectively.

LEVEL OF EVIDENCE

Level I, therapeutic study.

Persistent mental and physical health impact of exposure to the September 11, 2001 World Trade Center terrorist attacks

BACKGROUND

Asthma, gastroesophageal reflux disease (GERD), posttraumatic stress disorder (PTSD) and depression have each been linked to exposure to the September 11, 2001 World Trade Center (WTC) terrorist attacks (9/11). We described the prevalence and patterns of these conditions and associated health-related quality of life (HRQOL) fifteen years after the attacks.

METHODS

We studied 36,897 participants in the WTC Health Registry, a cohort of exposed rescue/recovery workers and community members, who completed baseline (2003-2004) and follow-up (2015-16) questionnaires. Lower respiratory symptoms (LRS; cough, dyspnea, or wheeze), gastroesophageal reflux symptoms (GERS) and self-reported clinician-diagnosed asthma and GERD history were obtained from surveys. PTSD was defined as a score > 44 on the PTSD checklist, and depression as a score > 10 on the Patient Health Questionnaire (PHQ). Poor HRQOL was defined as reporting limited usual daily activities for > 14 days during the month preceding the survey.

RESULTS

In 2015-16, 47.8% of participants had ≥1 of the conditions studied. Among participants without pre-existing asthma, 15.4% reported asthma diagnosed after 9/11; of these, 76.5% had LRS at follow up. Among those without pre-9/11 GERD, 22.3% reported being diagnosed with GERD after 9/11; 72.2% had GERS at follow-up. The prevalence of PTSD was 14.2%, and of depression was 15.3%. HRQOL declined as the number of comorbidities increased, and was particularly low among participants with mental health conditions. Over one quarter of participants with PTSD or depression reported unmet need for mental health care in the preceding year.

CONCLUSIONS

Nearly half of participants reported having developed at least one of the physical or mental health conditions studied by 2015-2016; comorbidity among conditions was common. Poor HRQOL and unmet need for health were frequently reported, particularly among those with post-9/11 PTSD or depression. Comprehensive physical and mental health care are essential for survivors of complex environmental disasters, and continued efforts to connect 9/11-exposed persons to needed resources are critical.

United States Air Force Physician Assistant Postgraduate Specialty Training Factors: A Brief Survey

PURPOSE

The purpose of this study was to determine USAF physician assistants' (PAs') concerns regarding postgraduate education and training.

METHODS

This was a single-mode, observational, cross-sectional study using an anonymous-structured survey involving a population of 420 active duty USAF PAs. Potential participants were contacted by email and asked to take a one-time survey via a secure survey site link.

RESULTS

One hundred ten USAF PAs participated in the survey seeking their opinions on factors affecting applying for military postgraduate specialty training. The prime factors identified fell into 3 major groups of concern: types of degrees offered, current job satisfaction, and types of specialty training available. The most desired degree and specialty options were the doctorate of science and emergency medicine. Only a small number of respondents (6%) expressed current job satisfaction and the desire to remain in family medicine.

CONCLUSIONS

This study revealed important information to senior leaders who fund, recruit, train, and maintain force-readiness requirements. The 3 identified main priorities of respondents were the types of degrees, current level of job satisfaction, and the types of specialty training. The vast majority of those surveyed preferred the doctorate, which is what all of the specialty degrees in the Air Force are, except for ENT.

Effects of Psychiatric Comorbidity in Immune-Mediated Inflammatory Disease: Protocol for a Prospective Study

BACKGROUND

Immune-mediated inflammatory diseases (IMID), such as inflammatory bowel disease (IBD), multiple sclerosis (MS), and rheumatoid arthritis (RA), are highly prevalent in Canada and the United States and result in substantial personal and societal burden. The prevalence of psychiatric comorbidities, primarily depression and anxiety, in IMID exceeds those in the general population by two- to threefold, but remains underdiagnosed and undertreated. Furthermore, the effects of psychiatric comorbidity on IMID are not well understood.

OBJECTIVE

The objectives of this study were (1) to compare health-related quality of life and work ability in persons with IMID and psychiatric comorbidity with those of persons with IMID without psychiatric comorbidity and with those of persons with depression and anxiety disorders alone, and (2) to validate existing case identification tools for depression and anxiety in persons with IMID to facilitate improved identification of depression and anxiety by clinicians. To achieve these objectives, we designed a prospective 3-year longitudinal study. In this paper, we aim to describe the study rationale and design and the characteristics of study participants.

METHODS

Between November 2014 and July 2016, we recruited 982 individuals from multiple clinic and community sources; 18 were withdrawn due to protocol violations.

RESULTS

The final study sample included 247 participants with IBD, 255 with MS, 154 with RA, and 308 with depression or anxiety. The majority were white, with the proportion ranging from 85.4% (IBD [210/246]; MS [217/254]) to 74.5% (114/153, RA; P=.01). There was a female predominance in all groups, which was highest in the RA cohort (84.4%, 130/154) and least marked in the IBD cohort (62.7%, 155/247). Participants with depression or anxiety were more likely to be single (36.0%, 111/308) than participants in any other group (11.8% [30/255]-22.7% [56/247], P<.001).

CONCLUSIONS

This paper presents the rationale for this study, describes study procedures, and characterizes the cohort enrolled. Ultimately, the aim is improved care for individuals affected by IMID.