Abstract
BackgroundSurveys of doctors are an important data collection method in health services research. Ways to improve response rates, minimise survey response bias and item non-response, within a given budget, have not previously been addressed in the same study. The aim of this paper is to compare the effects and costs of three different modes of survey administration in a national survey of doctors.MethodsA stratified random sample of 4.9% (2,702/54,160) of doctors undertaking clinical practice was drawn from a national directory of all doctors in Australia. Stratification was by four doctor types: general practitioners, specialists, specialists-in-training, and hospital non-specialists, and by six rural/remote categories. A three-arm parallel trial design with equal randomisation across arms was used. Doctors were randomly allocated to: online questionnaire (902); simultaneous mixed mode (a paper questionnaire and login details sent together) (900); or, sequential mixed mode (online followed by a paper questionnaire with the reminder) (900). Analysis was by intention to treat, as within each primary mode, doctors could choose either paper or online. Primary outcome measures were response rate, survey response bias, item non-response, and cost.ResultsThe online mode had a response rate 12.95%, followed by the simultaneous mixed mode with 19.7%, and the sequential mixed mode with 20.7%. After adjusting for observed differences between the groups, the online mode had a 7 percentage point lower response rate compared to the simultaneous mixed mode, and a 7.7 percentage point lower response rate compared to sequential mixed mode. The difference in response rate between the sequential and simultaneous modes was not statistically significant. Both mixed modes showed evidence of response bias, whilst the characteristics of online respondents were similar to the population. However, the online mode had a higher rate of item non-response compared to both mixed modes. The total cost of the online survey was 38% lower than simultaneous mixed mode and 22% lower than sequential mixed mode. The cost of the sequential mixed mode was 14% lower than simultaneous mixed mode. Compared to the online mode, the sequential mixed mode was the most cost-effective, although exhibiting some evidence of response bias.ConclusionsDecisions on which survey mode to use depend on response rates, response bias, item non-response and costs. The sequential mixed mode appears to be the most cost-effective mode of survey administration for surveys of the population of doctors, if one is prepared to accept a degree of response bias. Online surveys are not yet suitable to be used exclusively for surveys of the doctor population.
Highlights
Surveys of doctors are an important data collection method in health services research
There is some suggestion that response rates for surveys of medical practitioners may be falling, with important implications for statistical inference, and for the extent to which results can be generalised and used to inform policy [1,2,3]
The aim of this study is to conduct a randomised trial and economic evaluation of an online survey compared to two types of mixed mode
Summary
Surveys of doctors are an important data collection method in health services research. The aim of this paper is to compare the effects and costs of three different modes of survey administration in a national survey of doctors. Interventions to improve response rates include incentive-based approaches (e.g. money, gifts, lottery and prize draws), design-based approaches (e.g. survey length, follow-up, content) and mode of administration (e.g. paper, internet, interview). The literature about factors influencing response rates is growing, there are three important gaps that this paper aims to address: i) a lack of evidence on the use of mixed mode survey designs; ii) a lack of evidence examining response bias and item non-response, in addition to response rate, and iii) a lack of evidence on the cost-effectiveness of different strategies
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